>> GOOD AFTERNOON, EVERYONE.
THIS IS BONITA V. WHITE, DIRECTOR OF DIVERSITY AND INCLUSION DIVISION FOR THE DEPARTMENT
OF HEALTH AND HUMAN SERVICES.
WE WOULD LIKE TO WELCOME YOU TO OUR LGBT PRIDE MONTH OBSERVANCE, THIS AFTERNOON, WE'RE FEATURING
A SEXUAL AND GENDER MINORITY HEALTH SEMINAR.
AND WE HAVE THREE OF THE DEPARTMENT'S MOST OUTSTANDING EMPLOYEES WHO WILL BE PRESENTING
ON TOPICS SUCH AS SEXUAL AND GENDER MINORITY HEALTH RESEARCH, A VIEW FROM THE NIH, THE
IMPACT OF SEXUAL AND GENDER MINORITY STATUS ON HEALTH, AND THE STRIDES IN ADDRESSING SEXUAL
AND GENDER MINORITY HEALTH CONCERNS.
WE THANK THOSE WHO JOINED US IN THE ROOM, AND THOSE WHO ARE LIVE STREAMING FOR BEING
WITH US TODAY.
BEFORE WE ACTUALLY GET STARTED AND HAVE OUR PRESENTERS JOIN US ON THE STAGE, WE WOULD
LIKE TO LET YOU KNOW ABOUT A COUPLE OF OTHER UPCOMING EVENTS.
NEXT THURSDAY THE 21st WE'RE GOING TO HAVE PRESENTATIONS FROM CYNTHIA RICHARDSOCROOKS,
DIRECTOR OF THE EEO COMPLIANCE AND OPERATIONS DIVISION, AND THAT PRESENTATION WILL BE A
PART OF OUR DAYTODAY DIVERSITY AND INCLUSION LUNCH AND LEARN SERIES, FOR LGBT PRIDE MONTH
WE'VE DETERMINED THAT WE WOULD HAVE OUR LUNCH AND LEARN SERIES DEDICATED TO THE TOPIC REGARDING
NONDISCRIMINATION POLICIES AND PROCEDURES RELATED TO TRANSGENDER EMPLOYEES.
IT'S GOING TO BE A VERY INTERESTING AND INFORMATIVE PRESENTATION.
SO, AGAIN, WE ASK YOU TO JOIN US.
WE ALSO INVITE YOU TO GO TO OUR WEBSITE OR SEND US AN EMAIL, DIVERSITY@HHS.GOV TO RECEIVE
UPDATES AND INFORMATION, NOT JUST PERTAINING TO OUR ACTIVITIES BUT ALSO PERTAINING TO THE
ACTIVITIES OF THE EMPLOYEE RESOURCE GROUPS THAT ARE PART OF THE DEPARTMENT.
WE'D LIKE TO REMIND YOU THAT WE HAVE SIX LGBT ERGs IN THE DEPARTMENT OF HEALTH AND HUMAN
SERVICES, AND IF YOU HAVE A MAX.GOV ACCOUNT YOU'LL BE ABLE TO GO TO OUR MAX.GOV PAGE AND
SEE A LISTING OF ERG EMPLOYEE RESOURCE GROUPS IN THE DEPARTMENT AND SEE AN AGENDA FOR TODAY,
AND YOU'LL BE ABLE TO SEE THE LISTING OF ALL LGBT ERGs IN THE DEPARTMENT.
AND WE'RE GOING TO TAKE A MOMENT AND ASK OUR SPEAKERS TO COME UP TO THE STAGE, AND WE'LL
INTRODUCE EACH AND TURN IT OVER TO THEM THEREAFTER.
OUR FIRST SPEAKER, KAREN PARKER, IS DIRECTOR, SEXUAL AND GENDER MINORITY RESEARCH OFFICE,
DIVISION OF PROGRAM COORDINATION, PLANNING AND STRATEGIC INITIATIVES IN THE OFFICE OF
DIRECTOR AT NIH, INSTRUMENTAL IN THE FORMATION OF THAT OFFICE IN THE FALL OF 2015 AND WAS
APPOINTED DIRECTOR IN JUNE OF 2016.
OFFICE COORDINATES NIH RESEARCH RELATED TO THE HEALTH AND GENDER AND SEXUAL MINORITIES
ACROSS NIH INSTITUTES, CENTERS AND OFFICES.
SHE ALSO SERVES AS COCHAIR OF THE TRANSNIH SEXUAL AND GENDER MINORITY RESEARCH COORDINATING
COMMITTEE, AND HAS SERVED ON THE COMMITTEE SINCE ITS INCEPTION IN 2011.
DR.
PARKER COMES TO THE NIH OFFICE OF THE DIRECTOR FROM THE NATIONAL CANCER INSTITUTE WHERE SHE
SERVED AS ACTING BRANCH CHIEF IN THE NCI OFFICE OF SCIENCE, PLANNING AND ASSESSMENT AND WOMEN'S
HEALTH OFFICER FOR THE INSTITUTE.
PRIOR TO THIS WAS SPECIAL ASSISTANT TO THE PRESIDENT'S CANCER PANEL.
SHE BEGAN 59 NIH IN 2001, AS A PRESIDENTIAL MANAGEMENT FELLOW.
SHE HAS LONG BEEN PART OF THE DISCUSSION ON DIVERSE HEALTH ISSUES AFFECTING SEXUAL AND
GENDER MINORITY COMMUNITIES AND NEED FOR INITIATIVES TO SUPPORT RESEARCH AND TRAINING IN THIS AREA.
DR.
PARKER IS PAST PRESIDENT OF THE ALLMAN CANCER FUND FOR YOUNG ADULTS, MASTER IN SOCIAL WORK,
SOCIAL POLICY AND EVALUATION, SHE COMPLETED Ph.D. AT UNIVERSITY OF MARYLAND, SCHOOL OF
SOCIAL WORK.
OUR SECOND SPEAKER IS CHRISTINA DRAGON, SEXUAL AND GENDER MINORITY LEAD IN ANALYTICS GROUP,
OFFICE OF MINORITY HEALTH, CENTERS FOR MEDICARE AND MEDICAID SERVICES, AT CMS WORKS ON TRANSGENDER
BENEFICIARY RESEARCH AND INCREASING SEXUAL ORIENTATION AND GENDER IDENTITY DATA COLLECTION,
PARTICIPATE ON SGM DATA RELATED WORK GROUPS, ALSO CHAIR OF CMS PRIDE FOR CMS EMPLOYEES,
WORKED AT THE NATIONAL CENTER FOR HEALTH STATISTICS AT DATA ANALYST FOR HEALTHY PEOPLE 2020 INITIATIVE
INCLUDING LGBT HEALTHS, MASTERS FROM JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH
AND DOUBLE MAJOR FROM SMITH COLLEGE IN NEUROSCIENCE AND WOMEN AND GENDER STUDIES.
IN FREE TIME SHE DRINKS THIRD WAVE COFFEE, ENTERTAINS HER HOUND DOG.
LAST SPEAKER THIS AFTERNOON IS ELLIOTT KENNEDY, WHO IS THE SENIOR ADVISER FOR LGBT HEALTH
IN THE OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH AT THE DEPARTMENT OF HEALTH AND HUMAN
SERVICES.
IN THIS ROLE ELLIOTT SERVES AS DEPARTMENTAL LEVEL AND LIAISON FOR LGBT ISSUES AND HELPS
SUPPORT WORK OF THE HHS LGBT ISSUES COORDINATING COMMITTEE.
HE WAS PREVIOUSLY SPECIAL EXPECT FOR LGBT AFFAIRS AT THE SUBSTANCE ABUSE AND MENTAL
HEALTH SERVICES ADMINISTRATION, SAMHSA, WHERE HIS WORK FOCUSED ON PLANNING AND COORDINATING
LGBT POLICY AND PROGRAMMATIC INITIATIVES, INTEGRATING LGBT CULTURAL COMPETENCY THROUGHOUT
AGENCY AND STAFFING LGBT ISSUES COORDINATING COMMITTEE.
PRIOR TO JOINING HHS, ELLIOTT WAS GOVERNMENT AFFAIRS COUNCIL AT THE TREVOR PROJECT, WHERE
HE ADVOCATED FOR LAWS AND REGULATIONS TO SUPPORT LGBTQ YOUTH AND YOUNG ADULT MENTAL HEALTH,
WORK FOCUSED ON INCREASING ACCESS TO MENTAL HEALTH SERVICES, BUILDING SAFE AND SUPPORTIVE
EDUCATIONAL ENVIRONMENTS, AND ENDING YOUTH HOMELESSNESS.
SO THERE YOU HAVE IT, ON ALL OF OUR PRESENTERS.
THEY WILL PRESENT IN THE ORDER THAT THEY HAVE BEEN INTRODUCED, AND AT THE END OF EACH PRESENTATION
THERE WILL BE AN OPPORTUNITY FOR Q&A.
THANK YOU, AGAIN, FOR JOINING US AND WE'LL NOW TURN IT OVER TO OUR FIRST SPEAKER, DR.
KAREN PARKER.
[APPLAUSE]
>> THANK YOU FOR THE INVITATION TO PROVIDE AN UPDATE ON WHAT THE NATIONAL INSTITUTES
OF HEALTH IS DOING IN THE RESEARCH SPACE.
SO FOR FOLKS WHO DON'T KNOW, THE NATIONAL INSTITUTES OF HEALTH DEFINES SEXUAL AND GENDER
MINORITIES, WE BASICALLY USE THAT TERM AS UMBRELLA PHRASE IT INCLUDES OTHERS WHO MAY
NOT IDENTIFY AS LESBIAN, GAY, BISEXUAL TRANSGENDER BUT WHO MAY BE GENDER NONCONFORMING, ASEXUAL,
THAT ENTIRE REALM OF PERSONS WHOSE HEALTH CONDITIONS WE'RE INTERESTED IN, INCREASING
RESEARCH ON, THIS ALSO INCLUDES FOLKS WITH DISORDERS OF SEX DEVELOPMENT, OFTENTIMES REFERRED
TO AS INTERSEX.
IN 2009 THE NATIONAL INSTITUTES OF HEALTH COMMISSIONED THE INSTITUTE OF MEDICINE TO
A REPORT ON THE HEALTH OF LGBT POPULATION.
NIH DEMONSTRATED THAT SUPPORT FOR THIS WORK, BECAUSE 17 OF OUR 24 INSTITUTES PROVIDED SUPPORT,
IN 2011 THAT WAS RELEASED AND WAS THE FIRST SEMINAL REPORT ON THE HEALTH OF LGBT PERSONS.
AND SO THIS REPORT WAS REALLY CRITICAL AT NIH BECAUSE WE WERE ABLE TO TAKE THAT REPORT
AND MAKE LOTS AND LOTS OF PROGRESS OVER THE PAST SEVERAL YEARS, SO I'M GOING TO TALK ABOUT
THAT PROGRESS.
THE REPORT RECOMMENDATIONS, FIRST DEPARTMENT OF HEALTH AND HUMANS SERVICES RECOMMENDED
THAT HHS IN GENERAL COLLECT ELECTRONIC HEALTH RECORDS INFORMATION ON SEXUAL ORIENTATION
AND GENDER IDENTITY AND LAID OUT A BROAD RANGE OF THINGS FOR NIH TO DO TO FOCUS SPECIFICALLY
ON LAYING OUT A RESEARCH AGENDA, MEASURES IN THE SPACE, THOSE TYPES OF THINGS.
THERE WERE SPECIFIC RECOMMENDATIONS RELATED TO RESEARCH AGENDA WHICH INCLUDED THINGS LINING
DEMOGRAPHIC RESEARCH, TRANSGENDER SPECIFIC HEALTH RESEARCH, REALLY A BROAD RANGE OF THINGS
THAT NIH REALLY SAT BACK AND SAID WHERE IS IT THAT NIH CAN MAKE THE MOST IMPACT AND HOW
CAN WE INCREASE OUR FUNDING IN THE ACTUAL RESEARCH TO BETTER UNDERSTAND THESE CONDITIONS.
SO OUR MAJOR RESPONSE TO THE REPORT, THE FIRST THING THAT THE NIH DIRECTOR DID WAS TO ESTABLISH
WHAT WAS THEN CALLED LGBT COORDINATING COMMITTEE, AND THAT GROUP CAME TOGETHER IN THE FIRST
YEAR TO BASICALLY DO PORTFOLIO ANALYSIS OF WHAT WE WERE FUNDING AND SO WE DID THAT PORTFOLIO
ANALYSIS, PRESENTED IT TO THE NIH DIRECTOR AND HE QUICKLY REALIZED WE WERE NOT FUNDING
ENOUGH, CONSIDERING ALL OF THE HEALTH ISSUES AND DISPARITIES THAT WERE POINTED OUT IN THE
INSTITUTE OF MEDICINE REPORT.
SO THAT COORDINATING COMMITTEE AFTER THAT REPORT BECAME A LONGSTANDING TRANSNIH COORDINATING
COMMITTEE, UPDATED ITS NAME IN 2012, LGBTI COORDINATING COMMITTEE INCLUDING INTERSEX
POPULATIONS, IN JANUARY OF 2015 MOVED TO LANGUAGE, SEXUAL AND GENDER MINORITY RESEARCH COORDINATING
COMMITTEE, STILL ACTIVE.
WE MEET MONTHLY AND LOOK AT TRANSNIH ACTIVITIES AND ISSUES THAT AS A GROUP WE CAN THINK ABOUT
HOW WE CAN HELP MOVE THEM FORWARD OR REMOVE BARRIERS.
SO ONE OF THE BIG THINGS THAT THAT COMMITTEE DID WAS AN NIH SGM STRATEGIC PLAN, THAT IS
CROSS NIH, SOMETHING THE RESEARCH OFFICE USES TO THINK ABOUT HOW WE'RE GOING TO MOVE FORWARD
BUT THIS PLAN IS FOR THE ENTIRE AGENCY, AND BASICALLY IT WAS DEVELOPED WITH LOTS OF INPUT
SO ONE OF THE FIRST THINGS WE DID WAS RFI REGARDING THE STRATEGIC PLAN, AND GOT COMMENTS
FROM THE PUBLIC, WORKED ACROSS NIH WITH PROGRAM OFFICERS, AND OTHER EXPERTS IN THIS AREA,
TO THINK ABOUT HOW WE SHOULD BE SHAPING STRATEGIC PLAN FOR THE OFFICE AND HELD THREE LISTENING
SESSIONS.
DR.
TABAK, DR.
MICHAEL GOTTESMAN AND DR.
COLLINS, DIRECTOR OF NIH, PARTICIPATED IN THE FIRST LISTENING SESSION.
DR.
TABAK WENT ON TO PARTICIPATE IN TWO OTHERS, ONE IN CHICAGO, ONE IN SAN FRANCISCO.
AND SO WE REALLY TOOK ACCEPTING PUBLIC COMMENT AND UNDERSTANDING WHAT THE EXTRAMURAL RESEARCH
COMMUNITY HAD TO SAY ABOUT THIS TO HEART.
OUR STRATEGIC PLAN WAS RELEASED IN LATE 2015.
GOAL ONE TO EXPAND THE KNOWLEDGE BASE, SO YOU CAN IMAGINE THAT MAKES SENSE, WE WORK
AT NIH, WE FUND RESEARCH.
THAT'S LIKE OUR BIG MAIN SORT OF PUSH OF THE STRATEGIC PLAN TO THINK ABOUT HOW WE CAN GET
FOLKS ACROSS ALL OF THE INSTITUTES AND CENTERS AT NIH THINKING ABOUT HOW DOES SEXUAL AND
GENDER MINORITY HEALTH INTERSECT WITH DISEASE OR HEALTH CONDITION THAT THAT INSTITUTE IS
LOOKING AT IN TERMS OF THEIR RESEARCH.
GOAL 2 TO REMOVE BARRIERS TO CONDUCTING THIS RESEARCH SO WE TAKE THIS GOAL AREA SERIOUSLY,
SO THE FIRST OBJECTIVE UNDER THIS GOAL AREA TO ESTABLISH AN OFFICE, SEXUAL AND GENDER
MINORITY RESEARCH OFFICE OF NIH WHICH WE DID, AND WE REALLY SERVE IN MANY WAYS AS POINT
OF CONTACT FOR EXTRAMURAL RESEARCHERS AND FOR INTRAMURALLY FOLKS AT NIH WHO HAVE QUESTIONS
OR WHO WANT TO THINK ABOUT HOW THEY CAN BETTER INCORPORATE SEXUAL ORIENTATION AND GENDER
IDENTITY QUESTIONS INTO THEIR WORK, THOSE THINGS, PEOPLE CAN COME TO OUR OFFICE.
IN GOAL 2 WE THINK ABOUT WAYS TO THINK ABOUT PEER REVIEW AND HOW THE CENTER FOR SCIENTIFIC
REVIEW WORKS AND ARE THERE BARRIERS TO APPLICANTS WHO ARE DOING RESEARCH IN SEXUAL AND GENDER
MINORITY HEALTH AND MAYBE REVIEWERS DON'T UNDERSTAND INTRICACIES, THINKING ABOUT A NASCENT
FIELD.
GOAL 3, TO STRENGTHEN THE COMMUNITY OF SCHOLARS WHO CONDUCT THIS WORK, TWOPRONGED WAY.
WE'RE INTERESTED IN STRENGTHENING THE COMMUNITY OF RESEARCHERS WHO ARE CONDUCTING SGMRELATED
WORK AND ALSO INTERESTED IN SGM RESEARCHERS DOING SCIENCE IN ALL TYPES OF AREAS, WHETHER
IT'S SEXUAL AND GENDER MINORITY HEALTH RESEARCH OR NOT.
SO WE REALLY WANT TO THINK ABOUT HOW CAN WE STRENGTHEN BOTH, IN SOME AREAS THERE'S OVERLAP,
IN OTHERS THERE IS NOT. AND SO NIH IS TAKING SERIOUSLY HOW CAN WE
BETTER TRAIN PEOPLE, HOW CAN WE PROVIDE MORE RESOURCES, HOW CAN WE HELP DO THINGS LIKE
PROVIDE MENTORING OR NETWORKING OPPORTUNITIES, FOR MAYBE POSTDOCS AND EARLY INVESTIGATORS,
WHO DON'T NECESSARILY HAVE A MENTOR WHO UNDERSTANDS NAVIGATING THIS AREA OF RESEARCH.
AND THEN GOAL 4 TO EVALUATE OUR PROGRESS, WE'RE DOING THAT BY HOPEFULLY VERY SOON PUBLISHING
PORTFOLIO ANALYSIS THAT WILL DEMONSTRATE TO PEOPLE WHERE OUR PORTFOLIO FITS, HOW MANY
GRANTS WE HAVE, AND I'LL TALK MORE ABOUT THAT IN A SECOND.
AND THEN ALSO WE'RE WORKING ON A SEXUAL AND GENDER MINORITY RESEARCH OFFICE ANNUAL REPORT
THAT WILL HOPEFULLY BE LIVE AND AVAILABLE SOON.
SO IN TERMS OF THE OFFICE, WHERE WE� SORRY.
LET ME GO BACK.
SO WE'RE MISSING A GRAPH HERE.
SO BASICALLY THAT DEMONSTRATES THERE ARE 27 DIFFERENT INSTITUTES AND CENTERS AT THE NATIONAL
INSTITUTES OF HEALTH, AND THE OFFICE OF THE DIRECTOR.
WE SIT WITHIN THE DIVISION OF PROGRAM COORDINATION PLANNING AND STRATEGIC INITIATIVES IN THE
OFFICE OF THE DIRECTOR, AND IT'S A VERY BUSY SLIDE, BUT THIS GIVES A SENSE OF WHERE WE
FIT WITHIN OUR DIVISION, A CROSSCUTTING OFFICE, WE WORK ON COLLABORATION AND COORDINATION
AND WE WANT THE BIRDSEYE VIEW.
OTHER OFFICES ARE OFFICE OF RESEARCH ON WOMEN'S HEALTH, BEHAVIORAL RESEARCH, AIDS RESEARCH,
REALLY WE'RE LOOKING AT THOSE AREAS OF RESEARCH WHERE WE DON'T WANT THEM TO BE SILOED WITHIN
ONE INSTITUTE OR CENTER.
SO WE DON'T WANT FOLKS AT THE NATIONAL INSTITUTE ON AGING TO SAY, OH, THE NATIONAL INSTITUTE
FOR MINORITY HEALTH AND HEALTH DISPARITIES ARE IN CHARGE OF THE SGM WORK.
WE WANT EVERY INSTITUTE AND CENTER TO THINK ABOUT INCORPORATING THIS INTO OUR RESEARCH
PORTFOLIO.
SO OUR OFFICE REALLY FOCUSES ON COORDINATING ACTIVITIES, AND COLLABORATING, AND LOOKING
FOR IS THERE INFRASTRUCTURE AT NIH, ARE THERE OPPORTUNITIES FOR US TO WORK ALONGSIDE INSTITUTES
AND CENTERS SO WE CAN REALLY MAXIMIZE OUR IMPACT AND SO THAT'S A LOT OF WHAT WE DO IS
WORKING ACROSS THE INSTITUTES AND CENTERS AND TO COLLABORATE, WE HAVE GREAT COLLABORATIONS
WITH MANY INSTITUTES AND CENTERS AND OTHER OFFICES WITHIN THE OFFICE OF THE DIRECTOR
SUCH AS OFFICE OF EQUITY DIVERSITY AND INCLUSION.
SO I'LL QUICKLY TALK ABOUT PORTFOLIO ANALYSIS AND GIVE YOU OVERARCHING SUMMARY.
IN FY 2015 WE FUNDED 301 PROJECTS, FOR NEARLY $162�MILLION, AND IN 2016 WE'RE GETTING
SOME PRELIMINARY DATA FROM FY 2016, AND TRENDS ARE LOOKING GOOD, WHERE WE'RE FUNDING MORE
PROJECTS FOR MORE MONEY, WHICH IS GREAT.
ABOUT 73% OF THAT PORTFOLIO IS IN HIV/AIDS, AND SO WE'RE REALLY THINKING ABOUT WAYS THAT
WE CAN LOOK AT THAT OTHER 27%, AND INCREASE RESEARCH IN THOSE SPACES SO THINKING ABOUT
THINGS LIKE CANCER, HEART DISEASE, SUICIDE, AND REALLY BEGINNING TO MAKE SURE THAT OUR
RESEARCH PORTFOLIO IS TAKING INTO ACCOUNT SEXUAL AND GENDER MINORITY POPULATIONS IN
A MORE HOLISTIC WAY.
THE NATIONAL INSTITUTER FOR ALLERGY AND INFECTIOUS DISEASE, FOR MENTAL HEALTH AND DRUG ABUSE
ACCOUNT FOR MAJORITY OF THE PROJECTS AND MAJORITY OF THE FUNDING WITHIN THIS SPACE.
AND WE DO FIND THAT LARGE NUMBERS OF PROJECTS SIT WITHIN A RELATIVELY SMALL NUMBER OF EXTRAMURAL
INSTITUTIONS, AND THAT SORT OF MAKES SENSE.
LOTS OF INSTITUTIONS DOING A LOT OF WORK ARE BECOMING MORE CENTERLIKE SO THERE ARE MENTORSHIP
OPPORTUNITIES AND NETWORKING OPPORTUNITIES, AND SO THEY ARE THE ONES WHO SORT OF HAVE
THE INFRASTRUCTURE IN ORDER TO COMPETE FOR NIH RESOURCES.
SO IN TERMS OF LEGISLATION, SO I'M SURE MANY PEOPLE HEARD ABOUT THE 21ST CENTURY CURES
ACT, SO THAT BIPARTISAN LEGISLATION DID INCLUDE SOME PROVISIONS RELATED TO SEXUAL AND GENDER
MINORITY HEALTH WHICH WAS GREAT SO BASICALLY THE 21ST CENTURY CURES ACT SAID THAT NIH NEEDED
TO IMPROVE RESEARCH IN SEXUAL AND GENDER MINORITIES AND SO THAT MEANT THE PUBLIC HEALTH SERVICE
ACT WAS AMENDED AND SO WE ARE THINKING ABOUT WAYS THAT WE CAN TRACK� INCREASE AND TRACK
SGM PARTICIPANTS IN CLINICAL RESEARCH, WE'RE CERTAINLY THINKING ABOUT WAYS WE CAN GET HOLD
OF MEASUREMENTS.
MANY PEOPLE KNOW THERE'S QUESTIONS RELATED TO MEASUREMENTS, ARE WE APPROPRIATELY CAPTURING
THE POPULATION, HOW DO MEASUREMENT NEEDS CHANGE OVER TIME ACROSS THE LIFESPAN?
HOW DO FOLKS' IDENTITY EVOLVE, WE THINKING ABOUT WAYS NIH CAN BEST THINK ABOUT THAT AND
THEN LAY OUT A RESEARCH AGENDA SPECIFIC TO MEASUREMENT.
AND METHODOLOGICAL CHANGES RELATED TO SMALL POPULATIONS, THINKING ABOUT HOW WORK RELATED
TO SGMs CAN BE INCORPORATED INTO THAT.
SO RECENT ACCOMPLISHMENTS OF THE OFFICE, SO IN TERMS OF GOAL 1, EXPANDING RESEARCH, WE
HAVE A NUMBER OF FUNDING OPPORTUNITY ANNOUNCEMENTS THAT HAVE BEEN ON THE STREET IN THE PAST,
SOME ARE STILL ACTIVE, THE OFFICE'S MAIN PROGRAM IN ARE ADMINISTRATIVE SUPPLEMENTS, IN 2015
FUNDED NINE OF THOSE, FOR NEARLY A MILLION DOLLARS, GREAT.
WE HAD A FUNDING OPPORTUNITY ANNOUNCEMENT ON THE STREET THAT IS ON THE HEALTH OF SEXUAL
AND GENDER MINORITY POPULATIONS AND WE ALSO HAVE SOME WORK DONE FOR THE DISORDERS OF SEX
DEVELOPMENT POPULATIONS.
GOAL 2, THE OFFICE WAS ESTABLISHED, ONE OF THE GREAT THINGS THAT HAPPENED AT NIH IN TERMS
OF BEING ABLE TO COORDINATE THE WORK.
THE DIVISION HAS THE COUNCIL OF COUNCILS, A GROUP OF EXTRAMURAL FOLKS WHO ADVISE THE
COUNCIL AND SO ESTABLISHED RESEARCH WORKING GROUP OF THAT COUNCIL AND SO WE HAVE SEVEN
EXPERTS WHO ADVISE OFFICE ON OUR WORK AND GIVE FEEDBACK ON WHERE WE'RE HEADED AND HOW
WE'RE IMPLEMENTING STRATEGIC PLAN AND YOU CAN SEE WE HAVE SEVERAL OTHER ACTIVITIES THAT
HAVE HAPPENED IN THAT SPACE.
IN TERMS OF GOAL 3, THE NIH ACADEMY IS A PROGRAM OUT OF THE OFFICE OF EXTRAMURAL TRAINING,
OFFICE OF INTRAMURAL TRAINING AND EDUCATION, AND THAT'S A PROGRAM THAT TRAINEES AT NIH
CAN APPLY FOR AND IT'S REALLY ABOUT HEALTH DISPARITIES RESEARCH AND IT'S ABOUT HELPING
PEOPLE UNDERSTAND MORE ABOUT THE BREADTH AND DEPTH OF HEALTH DISPARITIES AND SO THAT ACADEMY
HAS INCORPORATED WORK ON SEXUAL AND GENDER MINORITY HEALTH RESEARCH SO THAT'S BEEN REALLY
GREAT.
ANOTHER THING THAT HAPPENED IN OCTOBER, OCTOBER�6 OF 2016, DR.
ELISEO PEREZSTABLE, DIRECTOR OF NATIONAL INSTITUTE ON MINORITY, IN TERMS OF NIH RESEARCH, OPENING
UP SOME OF THE FUNDING OPPORTUNITIES ON HEALTH DISPARITIES TO FOLKS DOING SEXUAL AND GENDER
MINORITY HEALTH RESEARCH AND ALSO MADE PEOPLE WHO ARE DOING HEALTH DISPARITIES RESEARCH
ELIGIBLE FOR NIH LOAN REPAYMENT PROGRAM.
AND THEN GOAL 4 IN TERMS OF EVALUATING PROGRESS, NIH HAS WHAT'S CALLED NIH REPORTER, OUR PUBLIC
FACING WEBSITE WHERE PEOPLE CAN GO AND SEARCH ALL THE MANY GRANTS AT NIH AND SEE HOW WE'RE
SPENDING TAX DOLLARS AND TYPES OF PROJECTS WE'RE FUNDING.
WE WERE ABLE TO GET A CATEGORY IN THAT REPORTER WHICH MAKES IT EASY FOR FOLKS TO GO IN, SEARCH
SGM GRANT, LOOK FOR COLLABORATORS, SEE WHO IS BEING FUNDED FOR WHAT, WHAT INSTITUTION
THEY ARE AT, WHO THEIR PROGRAM OFFICER IS, SO IT'S A BREADTH OF KNOWLEDGE THAT NOW WE'RE
ABLE TO BETTER SEARCH AND BETTER PROVIDE ANALYSES OF OUR PORTFOLIO BECAUSE OF THAT.
WE ALSO DID AN FY 2015 PORTFOLIO ANALYSIS, WE'LL CONTINUE TO DO THOSE ON AN ANNUAL BASIS
TO LOOK AT TRENDS AND MONITOR PROGRESS IN INCREASING RESEARCH AND FINALLY WE GO BACK
TO THAT SGM FINGERPRINT AND VALIDATE THAT TO MAKE SURE WE'RE CAPTURING THE RIGHT GRANTS
WITHIN OUR PORTFOLIO THAT ARE IN FACT SGM RELATED.
NEXT STEPS, WE'RE INTERESTED IN EXPLORING NEW OPPORTUNITIES, ACROSS NIH AND THE DEPARTMENT.
AND WITH STAKEHOLDER.
WE ARE DEFINITELY WORKING WITH THE HHS LGBT COORDINATING COMMITTEE, AND WITH FOLKS LIKE
CHRISTINA AND OTHERS ESTABLISHED A WORKING GROUP SPECIFICALLY TO FOCUS ON RESEARCH AND
SURVEILLANCE SO WE KNOW THAT WE'RE TALKING ENOUGH SO THAT WE'RE UNDERSTANDING WHAT WE'RE
DOING AT OUR AGENCIES AND WORKING IN HOUSE AT NIH AT THE CLINICAL CENTER TO MAKE SURE
THAT WE HAVE SGM FRIENDLY POLICIES IN PLACE, WORKING ON TRAINING PEOPLE WORKING WITH SEXUAL
AND GENDER MINORITIES, WE WILL BE COLLECTING GENDER IDENTITY AND SEXUAL ORIENTATION DATA
AT THE NIH IN THEIR VERY SPECIFIC ELECTRONIC HEALTH RECORD.
SO I THINK THAT'S ALL THAT I HAVE IN TERMS OF AN UPDATE.
I'M HAPPY TO TAKE QUESTIONS.
>> WE HAVE MICROPHONES IN THE ROOM, IF YOU'RE ASKING A QUESTION YOU'LL NEED TO USE IT SO
THE PEOPLE WHO ARE LIVE STREAMING CAN HEAR THE QUESTION.
>> YOU MENTIONED IN YOUR 2015 PORTFOLIO ANALYSIS THAT YOU SPENT NEARLY $162�MILLION, APRIL
ASSUMING ON 301 PROJECTS, MOSTLY RESEARCH, WHAT ARE SOME RESULTS YOU'RE GETTING FROM
THOSE FUNDED PROJECTS?
>> OH, THAT'S A GREAT QUESTION.
I DON'T FEEL PARTICULARLY PREPARED TO ANSWER THAT.
WELL, SO LIKE I MENTIONED, A LOT OF WORK WE'RE DOING IS IN HIV/AIDS, AND SO THERE'S LOTS
OF WORK IN VACCINES, TRYING TO GET A VACCINE SORT OF UP AND RUNNING.
AND SO A LOT OF THAT WORK IS BEING DONE IN SEXUAL AND GENDER MINORITY POPULATIONS.
A LOT OF WORK IN PrEP, THERE HAS BEEN AN INFLUX LATELY IN TRANSGENDERSPECIFIC HEALTH RESEARCH
AND SO LOOKING AT THINGS LIKE PrEP UPTAKE AND TRANSGENDER WOMEN, THOSE TYPES OF THINGS.
HIV/AIDS WORK IS DONE IN PLACES LIKE THE NATIONAL INSTITUTE FOR MENTAL HEALTH AND DRUG ABUSE,
LOOKING AT INTERACTION BETWEEN DRUG ABUSE AND HIV/AIDS PATIENTS, THOSE TYPES OF THINGS,
AND HOPEFULLY BEING ABLE TO THEN CREATE INTERVENTIONS THAT CAN BE PUT OUT THAT ARE CULTURALLY APPROPRIATE,
AND CAN THEN BASICALLY HELP PREVENT AIDS, HELP TREAT, HELP PEOPLE BETTER ADHERE, THOSE
TYPES OF THINGS.
THERE'S OTHER WORK BEING DONE IN TOBACCO CESSATION, LOOKING AT SPECIFIC TAILORED NEEDS OF SEXUAL
AND GENDER MINORITY COMMUNITIES IN TERMS OF HOW WE CAN BEST REACH THEM TO HELP WITH THE
CESSATION, PREVENTION, THOSE TYPES OF THINGS.
>> IS THIS ON?
YEAH.
YEAH, ACTUALLY PIGGYBACKING OFF THE LAST QUESTION, THREEQUARTERS OF THE FUNDING GOING TO HIV/AIDS
IS A BIG NUMBER, AND OBVIOUSLY HIV/AIDS IS A BIG PROBLEM.
BUT, YOU KNOW, THIS MIGHT BE JUST LIKE TO YOUR MIND, WHAT ARE AREAS THAT YOU AREN'T
CURRENTLY FUNDING OR HAVEN'T LOOKED AT THAT MUCH THAT WOULD BE GOOD PRIORITIES FOR THE
FUTURE.
>> SOMETHING IN OUR OFFICE WE THINK OF A LOT.
FOCUSING ON MENTAL HEALTH, SUICIDE, THAT'S A HUGE PROBLEM.
RESILIENCE, PROTECTIVE FACTORS, NOT AS MUCH RESEARCH LOOKING MORE AT THE POSITIVE, FAMILY
FORMATION, GENDER IDENTITY FORMATION, AND CARDIOVASCULAR DISEASE.
WE HAVE VERY LITTLE RESEARCH ON CARDIOVASCULAR DISEASE.
ARE THERE ISSUES RELATED TO INCREASED MINORITY STRESS, SEXUAL STIGMA, HOW ARE THOSE THINGS
IMPACTING CARDIOVASCULAR DISEASE, WE NEED TO LOOK MORE AT DIABETES, CANCER, INTERACTION
IN THE HEALTH CARE SYSTEM.
SO ARE THERE SPECIFIC STIGMAS WITHIN THE INTERACTION, FOR EXAMPLE IOM REPORTED HOW THE HEALTH CARE
SYSTEMS DISCRIMINATE AGAINST FOLKS AND HOW IS THAT IMPACTING PEOPLE'S WILLINGNESS TO
GO TO THE DOCTOR, PREVENTIVE CARE, SMOKING IS AN ISSUE, TEEN PREGNANCY IS AN ISSUE NOT
BEING LOOKED AT THAT MIGHT BE INCREASED ISSUE IN SGM COMMUNITIES.
THERE ARE LOTS OF UNANSWERED QUESTIONS SO WHEN OUR OFFICE IS WORKING WITH INSTITUTES
AND CENTERS WE'RE NOT SAYING DON'T FUND THE HIV/AIDS STUFF, THAT'S CRITICAL AND WILL CONTINUE
TO BE FUNDED.
WE HAVE THE NATIONAL INSTITUTES ON ALLERGY AND INFECTIOUS DISEASE BUT WE WANT TO GET
A LOT OF OTHER INSTITUTES AND CENTERS TO THINK ABOUT WHERE ARE THE OTHER REALLY LARGE GAPS.
WHEN WE TALK ABOUT PRIORITIES, HIV/AIDS IS CRITICAL BUT OTHER DISEASE AREAS YOU CAN IMAGINE
WE DON'T KNOW IF A LOT OF CASES IF THERE ARE HEALTH DISPARITIES BECAUSE NOBODY ASKED THE
QUESTIONS OR LOOKED, SO THAT'S ONE REASON WHY WE NEED TO BEGIN TO MAKE SURE THAT LARGE
SURVEYS AND OTHER RESEARCH STUDIES ARE ASKING QUESTIONS ABOUT SEXUAL ORIENTATION AND GENDER
IDENTITY SO YOU CAN BEGIN TO UNDERSTAND ARE THERE DIFFERENCES WITHIN HEALTH OUTCOMES.
>> DO YOU HAVE ANY OTHER QUESTIONS?
>> SO YOU'RE FOCUSING ON INCREASING RESEARCH, SPECIFIC SGM COMMUNITY RESEARCH.
BUT ARE THERE THINGS YOU'RE DOING OR CAN DO TO MAKE SURE THAT OTHER FUNDING AT NIH ON
TOPICS NOT NECESSARILY SPECIFIC TO SEXUAL AND GENDER MINORITIES, INCORPORATES THAT INTO
THE RESEARCH, OR LIKE DOESN'T MISS OUT ON ISSUES OF, YOU KNOW, IF YOU HAVE LIKE TRANSGENDER
PEOPLE IN THE POPULATION THAT YOU'RE USING.
>> YES, SO THAT GOAL 1 WHEN WE THINK ABOUT EXPANDING RESEARCH, WE'RE INTERESTED IN EXPANDING
RESEARCH THAT'S SPECIFIC TO SGM POPULATIONS BUT AT NIH WE TALK ABOUT WHAT'S THE RESEARCH
CURRENTLY HAPPENING THAT WE CAN EVEN JUST ASKING ABOUT SEXUAL ORIENTATION AND GENDER
EYE DIDN'T SO HAVE YOU DATA TO ANALYZE.
WE TALK ABOUT DIABETES AND CANCER, INCORPORATING, THAT'S THE TECHNICAL ASSISTANCE, FOR PEOPLE
ACROSS DIFFERENT INSTITUTES AND CENTERS WHO WANT TO INCLUDE THIS, WHERE DO WE START?
AND WE HAVE LARGE COHORTS OUT OF NIH AND NEW ONES STARTING, WE REACHED OUT TO THEM, HEY,
YOU'RE STARTING THIS COHORT OF THOUSANDS AND THOUSANDS OF PEOPLE, ARE YOU ASKING ABOUT
SEXUAL ORIENTATION AND GENDER IDENTITY?
SGM PORTFOLIO, 301 APPLICATIONS FUNDS, 60% OF THOSE APPLICATIONS COME IN THROUGH FUNDING
OPPORTUNITY ANNOUNCEMENT ALSO NOT SEXUAL AND GENDER MINORITY SPECIFIC, THOSE ARE APPLICATIONS
WHERE SOMEBODY WANTS TO LOOK AT DIABETES OR FIBROMYALGIA, ANY NUMBER OF ISSUES, IT'S AN
SGMSPECIFIC POPULATION, SO I'M TELLING RESEARCHERS INTERESTED IN THIS AREA, YES, WE HAVE SGMSPECIFIC
FUNDING ANNOUNCEMENTS BUT THINK ABOUT THE TOPIC AREA THAT YOU'RE LOOKING AT AND REGARDLESS
OF YOUR POPULATION THERE ARE FUNDING OPPORTUNITIES THAT MIGHT FIT WITHIN WHAT YOU'RE WORKING
ON SO WE TALK ABOUT THAT A LOT BECAUSE JUST LOOKING AT SGM POPULATIONS IN A BUBBLE IS
NOT GOING TO GIVE US ALL THE ANSWERS THAT WE NEED.
>> ANY OTHER QUESTIONS IN THE ROOM?
>> YES, HI, JERRY COLBERT, TEMPORARY OWH.
I HAD A QUESTION ABOUT CONGRUENCE.
WHERE DO YOU GET YOUR DEFINITIONS FROM, SEXUAL AND GENDER MINORITY?
>> IT'S IT'S DEFINITION NIH DEVELOPED IN OUR RESEARCH.
WHEN PEOPLE THINK ABOUT SEXUAL AND GENDER MINORITIES THEY ARE NOT INCLUDING PEOPLE WITH
DISORDERS OR INTERSEX DEVELOPMENT, INTERESTED IN INCREASING RESEARCH IN THESE AREAS, WE
KNOW THERE'S A DEARTH OF RESEARCH IN THAT SPACE AND THERE ARE SOME COMMONALITIES, WE
DECIDED TO INCLUDE THOSE IN OUR WORK AND MOVED AWAY FROM LGBT BECAUSE THE LANGUAGE IS EVOLVING,
WE WANT TO BE CURRENT AS WE MOVE FORWARD AND TO KNOW WE'RE REALLY INTERESTED IN BETTER
UNDERSTANDING HEALTH SO THAT HEALTH CAN BE IMPROVED ACROSS A VARIETY OF DIFFERENT POPULATIONS.
GREAT.
THANK YOU >> WELL, THANK YOU VERY MUCH, DR.
PARKER.
WE APPRECIATE YOUR PRESENTATION.
[APPLAUSE]
>> CHRIS HAFFER IS MY BOSS, DEFINITELY NOT ME.
I HOPE THESE ARE MY SLIDES.
I CAN'T DO THIS EITHER.
OKAY.
GOOD AFTERNOON, I'M CHRISTINA DRAGON, I WORK IN CHRIS HAFFER'S GROUP AT CENTERS FOR MEDICARE
AND MEDICAID SERVICE IN THE OFFICE OF MINORITY HEALTH.
I'M THE SEXUAL AND GENDER MINORITY DATA LEAD.
I'M GOING TO GIVE YOU AN OVERVIEW OF OFFICE OF MINORITY HEALTH, TALK ABOUT OUR HEALTH
EQUITY PLAN FOR IMPROVING CARE IN MEDICARE, AND THEN I'M GOING TO TALK A LITTLE BIT ABOUT
OUR GROUP AND THE WORK THAT OUR GROUP DOES, SOME OF OUR DATA PRODUCTS AND FOCUS ON THE
SGM PORTFOLIO AND SOME STUFF WE'VE BEEN WORKING ON.
IF YOU CAN READ THE TEXT YOUR EYESIGHT IS BETTER THAN MINE.
WE PRIMARILY FOCUS AS AN INTERNAL RESOURCE FOR CMS, AND PROVIDE GUIDANCE AROUND MINORITY
POPULATIONS, HEALTH EQUITY, AND SERVE AS RESOURCE FOR COMPONENTS AS WELL AS LIAISING WITH OTHER
OFFICES IN HHS AND OTHER FEDERAL AGENCIES.
WE SERVE ON A COUPLE OMB COMMITTEES THAT PERTAIN TO COLLECTING DATA AROUND MINORITY POPULATIONS
LIKE SEXUAL AND GENDER MINORITY OR RACE/ETHNICITY, HARD TO MEASURE OR SMALL SAMPLE SIZE POPULATIONS.
SO FOCUSING ON OUR HEALTH EQUITY PLAN, THIS WAS DEVELOPED IN THE FALL OF 2015, AND WE
DESIGNED IT AROUND SEVERAL FOCAL AREAS, I'M FOCUS ON EXPANDING DATA COLLECTION.
WE WANT TO MAKE SURE DATA IS QUALITY AND HAS BEEN COLLECTED WITH THE UTMOST METHODOLOGICAL
RIGOR BUT ALSO IT'S BEING TRUE TO THE POPULATIONS THAT WE'RE TRYING TO MEASURE.
WIN DATA AND POLICY ANALYTICS GROUP, DPAG, WHERE CHRIS AND I ARE LOCATED, WE WANT TO
NOT ONLY EXPAND DATA COLLECTION BUT ALSO STRENGTHEN THE INTEGRITY OF THE DATA THAT WE'RE COLLECTING.
SO IF YOU'RE AT ALL FAMILIAR WITH MEDICARE OR MEDICAID, YOU KNOW THAT OUR DATA IS NOT
NECESSARILY LIKE SOME OF THE OTHER LARGE SCALE HEALTH SURVEYS.
A LOT OF IT IS CLAIMS DATA.
THEREFORE YOU DON'T NECESSARILY HAVE STANDARD ERRORS BECAUSE YOU'RE NOT SAMPLING.
YOU HAVE A TOTAL SUM OR CENSUS OF THE POPULATION DATA THAT YOU'RE WORKING WITH.
AND SO IT'S A LITTLE BIT DIFFERENT TALKING ABOUT CLAIMS ANALYSIS WHERE PEOPLE ARE USED
TO POPULATION LEVEL ANALYSIS.
WE'RE INTERESTED IN EXPANDING CAPACITY OF CMS TO COLLECT STRONG DATA ON POPULATION THAT
THEY HAVEN'T NECESSARILY INCLUDED BEFORE.
ONE OF THE CHALLENGES WE HAVE IS THAT A LOT OF OUR MEDICARE BENEFICIARIES, THEIR INFORMATION
DRAWS DIRECTLY FROM THE SOCIAL SECURITY ADMINISTRATION, SO SOME OF OUR DATA IS LIMITED BY WHAT SSA
COLLECTS, IN PERSON FILED RECORDS BUT THERE ARE OTHER WAYS WE CAN WORK AROUND THAT AND
I'LL GET INTO THAT A LITTLE BIT LATER.
JUST GOING BACK, ON THE LEFT SIDE OR I GUESS YOUR RIGHT SIDE OF THE SCREEN WE HAVE ONE
OF OUR DATA HIGHLIGHTS.
WE TRIED TO PRODUCE A COUPLE ANALYTICS PRODUCTS EVERY YEAR QUARTER, EITHER A DATA HIGHLIGHT,
LIKE A DATA BRIEF SIMILAR TO SHORT FORM JOURNAL ARTICLE BUT THAT WE DON'T NECESSARILY SUBMIT
THROUGH PEER REVIEW BECAUSE IT'S BASED ON OUR OWN WORK INTERNAL TO THE OFFICE.
AND THEN ALSO SHORTER BRIEFS, DATA SNAPSHOTS, ONE PAGE, SUPPOSED TO BE EASILY ACCESSIBLE,
LAYPERSON'S EXPLANATIONS OF A PARTICULAR POPULATION.
SO WHAT ARE LGBT HEALTH DISPARITIES AND HEALTH NEEDS?
WE TEND TO USE SEXUAL AND GENDER MINORITY AS THE OVERARCHING TERM.
ALTHOUGH WHEN WE'RE TALKING IN TERMS OF EDUCATING OTHERS WE TRY TO USE THE LANGUAGE THEY MIGHT
BE THE MOST FAMILIAR WITH, A LOT OF OUR DEFINITIONS WE BORROWED FROM NIH BECAUSE WE WANTED TO
BE IN LINE WITH THE MOST CURRENT RESEARCH AVAILABLE, BUT WE DO TRY TO MAKE IT MORE ACCESSIBLE
FOR CLINICIANS AND POTENTIALLY BENEFICIARIES WHO ARE INTERESTED AS WELL.
SO SOME OF YOU MAY RECALL THAT BACK MANY YEARS AGO HEALTHY PEOPLE 2010 HAD A COMPANION DOCUMENT
THAT WAS ISSUED BY THE GAY AND LESBIAN MEDICAL ASSOCIATION, AND THAT PROVIDED AN OUTLINE
OF SOME OF THE AREAS THAT A LOT OF CLINICIANS WHO WORKED WITH SEXUAL AND GENDER MINORITY
POPULATIONS FELT WERE REALLY IMPORTANT TO THE COMMUNITY.
WHETHER THOSE BE LACK OF ACCESS TO CERTAIN HEALTH SERVICES OR WHETHER IT MIGHT BE DISPROPORTIONAL
DISEASE BURDEN, IN SOME CASES.
KAREN TOUCHED ON A LOT OF THOSE ISSUES.
FROM THAT HEALTHY PEOPLE 2020 ACTUALLY DEVELOPED A TOPIC AROUND AROUND INCREASING DATA COLLECTION
AROUND LGBT POPULATIONS, AND SO THAT'S ONE OF THE FOUNDATIONAL AREAS THAT WE LIKE TO
TOUCH ON TO SAY, YOU KNOW, THERE IS A REALLY GOOD FOUNDATION FOR SHOWING THAT THERE HAS
BEEN A LACK OF DATA TO PROVE WHETHER OR NOT THOSE DISPARITIES ARE REALLY, REALLY JUSTIFIED.
THERE ARE A LOT OF BARRIERS TO ACCESS IN CARE, IMPORTANT BECAUSE OF MEDICARE'S FOCUS ON THOSE
WHO ARE DISABLED OR OVER THE AGE OF 65, IT ALSO COVERS THOSE WHO HAVE END STAGE RENAL
DISEASE, ALTHOUGH IT IS MUCH MORE CHALLENGING TO CONDUCT LONGTERM RESEARCH ON THAT SUBSET
OF THE POPULATION JUST BECAUSE THEY DON'T TEND TO BE IN OUR CLAIMS DATA FOR VERY LONG.
SO ONE OF THE MAIN THINGS THAT WE TRY TO ADDRESS IS HOW CAN WE FRAME OUR RESEARCH IN A WAY
THAT WE ARE ADDRESSING HISTORICAL LACK OF ACCESS, PARTICULARLY FOR THOSE WHO MIGHT BE
SEXUAL AND GENDER MINORITY OLDER ADULTS.
WE FOCUS ON THE OLDER POPULATIONS, JUST BECAUSE THAT IS OBVIOUSLY WHAT MEDICARE SPENDS A LOT
OF THEIR TIME WORKING ON, AND WHAT'S IMPORTANT TO REALIZE IS THAT UNTIL 1962, IN ALL 50 STATES
BEING GAY WAS CONSIDERED A CRIMINAL OFFENSE.
AND UNTIL 1973, IT WAS ACTUALLY INCLUDED IN THE AMERICAN PSYCHOLOGICAL ASSOCIATION'S LIST
OF MENTAL ILLNESSES SO I THINK SOMETIMES WE LOSE SIGHT OF HOW MUCH PROGRESS WE REALLY
HAVE MADE IN A VERY SHORT AMOUNT OF TIME.
UNTIL 2012 GENDER IDENTITY DISORDER WAS INCLUDED IN THE DSMIV, AND IT WASN'T UNTIL 2012 THAT
IT WAS CHANGE IT'S TO GENDER DYSPHORIA, AND SO NOW WE'RE ABLE TO REALLY LOOK AT SEXUAL
AND GENDER MINORITY HEALTH, AS ANOTHER DEMOGRAPHIC VARIABLE THAT CAN INFLUENCE HEALTH OUTCOMES
IN THE SAME WAY THAT SOMEBODY'S SOCIOECONOMIC STATUS, RACE/ETHNICITY, COUNTRY OF ORIGIN
POTENTIALLY OR DISABILITY STATUS MIGHT ALSO INFLUENCE THEIR HEALTH OUTCOMES.
SO THESE ARE THE FOUR� THAT'S REALLY HARD TO READ.
THESE ARE THE FOUR PRIMARY FOCAL POINTS OF OUR SGM PORTFOLIO, AND I'LL ADDRESS EACH ONE
IN TURN.
THE FIRST IS FOCUSED ON SEXUAL MINORITY RESEARCH FOR THOSE AGE 65 AND OLDER USING THE NATIONAL
HEALTH INTERVIEW SURVEY DATA.
THE SECOND IS FOCUSED ON TRANSGENDER MEDICARE BENEFICIARIES.
AND THE THIRD IS FOCUSED ON COLLECTING SEXUAL ORIENTATION AND GENDER IDENTITY DATA, MOSTLY
IN CLINICAL SETTINGS.
ALTHOUGH WE HAVE DONE A LITTLE BIT OF EXPLORATION INTO HOW WE COULD BETTER INCLUDE IT IN MEDICARE
SURVEYS AND DATA COLLECTION METHODS ALSO.
AND ALSO OUR RESEARCH, HEALTH EQUITY RESEARCH SEATS THAT WE OFFER.
THIS IS GIVES MORE DETAIL ABOUT EACH OF THOSE AREAS, IT DOES NOT ESPECIALLY LOOK LIKE THE
SLIDES TRANSFERRED VERY WELL AFTER 508 COMPLIANCE WAS DONE SO MY DEEPEST APOLOGIES FOR THAT.
SO OUR WORK AROUND SEXUAL MINORITY, OLDER SEXUAL MINORITIES, THIS RESEARCH STARTED EARLY
LAST YEAR, WHEN MY BOSS, CHRIS, WAS LOOKING FOR SOME DATA ABOUT THE MEDICARE POPULATION
WHO ALSO IDENTIFIED AS LESBIAN, GAY OR BISEXUAL.
AND THERE WASN'T PARTICULARLY A LOT OF DATA AVAILABLE.
SO WE STARTED WORKING ON COMBINING THE DATA THAT WAS AVAILABLE AT THE TIME, WHICH WAS
2013 AND 14 DATA FROM THE NATIONAL HEALTH INTERVIEW SURVEY.
AND AS YOU MIGHT RECALL, 2013 WAS THE FIRST YEAR THAT THEY ADDED A SEXUAL ORIENTATION
QUESTION OR SEXUAL IDENTITY QUESTION TO THE NATIONAL HEALTH INTERVIEW SURVEY.
SO THESE WERE THE FIRST TWO YEARS OF DATA THAT WE LOOKED AT.
AND EVEN THEN COMBINING TWO YEARS OF DATA, NHIS IS ONE OF THE LARGEST HEALTH SURVEYS
IN THE COUNTRY AND WE CAME ONE 174 RESPONDENTS WHO PROVIDED INDICATION OF LESBIAN, GAY OR
BISEXUAL WITHIN A VERY LARGE SAMPLE OVER THE TWO YEARS.
SO I THINK ONE OF THE MOST INTERESTING THINGS TO FOCUS ON IS THAT IF YOU LOOK AT THE MARITAL
STATUS, YOU CAN SEE SOME PRETTY LARGE DIFFERENCES IN THOSE WHO ARE SEXUAL MINORITY, REPORTING
BEING MARRIED OR LIVING WITH PARTNERS, COMPARED TO THOSE WHO IDENTIFIED AS HETEROSEXUAL.
THIS IS A LITTLE BIT OF OUR DATA.
WE FOUND THAT THERE ARE ONLY IN THE 12, 14 OR SO HEALTH INDICATORS THAT WE LOOKED AT
CLOSELY, THERE WERE FOUR THAT HAVE SOME SIGNIFICANT DIFFERENCES.
AND BASICALLY IT CAN BE SUMMARIZED THAT SEXUAL MINORITIES OVERWHELMINGLY REPORT THAT THEY
FEEL THAT THEY ARE IN EXCELLENT OR VERY GOOD HEALTH, COMPARED TO HETEROSEXUALS, 63% COMPARED
TO 46%.
HOWEVER, THIS DATA ALSO CONFIRMS THAT EVEN AS PEOPLE AGE, FOR THE 65 AND OVER POPULATION,
BINGE DRINKING IS DOUBLE WHAT IT IS FOR HETEROSEXUALS, CONFIRMING PRIOR RESEARCH THAT HAD BEEN DONE
THROUGH THE NATIONAL HEALTH AND NUTRITION SURVEY, OR THROUGH THE BRFSS, THE BEHAVIOR
RISK FACTOR SURVEILLANCE SURVEY.
YOU KNOW, THAT COMES FROM EDUCATIONAL RESEARCHERS AT PUBLIC OR PRIVATE UNIVERSITIES.
OTHER INTERESTING THINGS TO TALK ABOUT SEXUAL MINORITIES RECEIVED FLU VACCINES AT HIGHER
RATES THAN HETEROSEXUAL PEERS AND ASTRONOMICALLY RECEIVE MORE HIV TESTING, MORE FUND GOES BECAUSE
OF THE LEGACY OF HOW IT AFFECTED SEXUAL MINORITIES.
TURNING NEXT TO OUR TRANSGENDER MEDICARE BENEFICIARY RESEARCH, USING FEE FOR SERVICE CLAIMS DATA,
FINAL ACTION CLAIMS DATA, SO WHEN WE FIRST STARTED LOOKING AT THIS WE WENT THROUGH AN
ITERATIVE PROCESS TO IDENTIFY ICD9 CODES THAT COULD BE RELATED TO RECEIVING CARE ASSOCIATED
WITH TRANSITION SERVICES.
I WON'T GET INTO THE METHODOLOGICAL DETAILS BUT LOOK FOR OUR PAPER AVAILABLE ON THE CMS
WEBSITE, THE FIRST OF HOPEFULLY MULTIPLE PAPERS THAT WE HAVE BEEN ABLE TO GET PUBLISHED IN
TRANSGENDER HEALTH, ON THIS POPULATION.
THIS PAPER AND DATA THAT I'M SHOWING CAME FROM CLAIMS FROM 2013, AND WE WERE ABLE TO
IDENTIFY 3658 TRANS PEOPLE, LIKELY TRANS PEOPLE.
AND WE CONSIDER THAT COULD BE A LOWER BOUNDS ESTIMATE, OBVIOUSLY WE'RE MISSING MEDICARE
BENEFICIARIES WHO WERE NOT RECEIVING SERVICES THROUGH THEIR MEDICARE PROVIDER, OR WHO MAY
NOT HAVE TAKEN STEPS TO TRANSITION MEDICALLY IN ANY WAY YET.
SO THE IMPORTANT THING I KNOW IT'S VERY SMALL TO SEE, BUT THE MAP INDICATES THAT IN FACT
ACROSS THE ENTIRE COUNTRY, THERE IS DISBURSEMENT OF TRANS BENNIES, THEY ARE EVERYWHERE, WE
LIVER IN ALL THE STATES, LIKE EVERYBODY ELSE.
A COUPLE STATES DON'T HAVE NUMBERS IN THEM, THAT'S JUST BECAUSE IT WAS SUCH A SMALL N
WE HAD TO SUPPRESS IT.
BUT I THINK THAT'S ONE OF THE LARGEST CASES THAT WE TRIED TO MAKE AROUND COLLECTING DATA
FOR SEXUAL AND GENDER MINORITY POPULATIONS IS TRYING TO REINFORCE THAT, YES, THEY ARE
NOT ABSENT IN ANY SPACES.
AND THEN I WILL ZOOM IN ON THE TOP SLIDE.
THIS IS AN AGE DISTRIBUTION OF THESE TRANS BENNIES THAT WE FOUND.
THE BULK OF POPULATION IS SKEWED IN THE UNDER 64 RANGE, THERE ARE QUITE A FEW AND THERE'S
EVEN 1.2% IN THE 85+ RANGE, KIND OF INTERESTING AND COOL AND I THINK THAT SAYS A LOT ABOUT
THE RESILIENCY OF THE OLDER POPULATION WHO CAME OF AGE IN A TIME WHERE THEY DIDN'T NECESSARILY
HAVE ACCESS TO HORMONES OR APPROPRIATE CARE.
SO THIS IS ANOTHER CHART THAT JUST SHOWS A LITTLE BIT OF BREAKDOWN FOR THE TOP 20 CHRONIC
CONDITIONS THAT TRANS MEDICARE BENEFICIARIES EXPERIENCE.
THE DARKER BARS ARE FOR THOSE UNDER 65, AND THE LIGHTER BARS ARE FOR THOSE OVER 65.
AS YOU CAN NOTICE, SOME OF THOSE THINGS SWITCH AROUND A LITTLE BIT, AS PEOPLE AGE.
AND SO THAT'S SOMETHING THAT'S PARTICULARLY INTERESTING FOR US.
SOME OF OUR MORE RECENT RESEARCH HAS INDICATED THAT MOST OF OUR TRANS BENNIES, NOW THAT WE
LOOKED AT MULTIPLE YEARS, LOOKING AT FIVE YEARS OF DATA, QUALIFY FOR MEDICARE THROUGH
THE DISABILITY PATHWAY RATHER THAN AGE PATHWAY.
SO THAT'S ESPECIALLY INTERESTING, AND IT'S GOING TO BE REALLY IMPORTANT TO BE ABLE TO
TRACK HOW THE HEALTH NEEDS OF THAT POPULATION TRANSITION AS THEY AGE.
SO FOR THOSE UNDER 65, ONE OF THE MOST PREVALENT CHRONIC CONDITIONS IS DEPRESSION.
BUT YOU CAN SEE THAT AS PEOPLE AGE, THAT KIND OF DIMINISHES AND WHO KNOWS IF THAT'S JUST
LIKE RETROSPECTIVE, LIKE, YOU KNOW, OH, IT WAS REALLY BAD BACK THEN BUT LIKE, HEY, NOW
IT'S A LOT BETTER, OR WHO KNOWS HOW THAT COULD BE AFFECTING THE POPULATION.
WE CAN'T REALLY SPECULATE ON ANY OF THE CAUSAL FACTORS FOR THESE.
SO THE NEXT AREA THAT I'M GOING TO TALK ABOUT IS OUR FOCUS ON COLLECTING SEXUAL ORIENTATION
AND GENDER IDENTITY DATA IN CLINICAL SETTINGS, IN FEBRUARY WE RELEASED THROUGH THE MEDICARE
LEARNING NETWORK A TRAINING, IT'S ONE OUR LONG, AVAILABLE FOR CLINICIANS AND HOSPITAL
ADMINISTRATORS WHO ANYBODY ELSE WHO WOULD LIKE TO TAKE IT.
IT COVERS A LITTLE BIT OF INTRODUCTION TO TERMINOLOGY, OVERVIEW OF BACKGROUND AND HEALTH
DISPARITIES OR OBSTACLES TO CARE SEXUAL AND GENDER MINORITY FOLKS MIGHT FACE AND GOES
INTO SOME DETAILS ABOUT HOW CLINICIANS OR HEALTH CAR ADMINISTRATORS CAN WORK TO INCLUDE
OR COLLECT THIS DATA IN CLINICAL SETTINGS INCLUDING RECOMMENDED QUESTION SETS.
SINCE WE LAUNCHED IN FEBRUARY WE HAD 200 PEOPLE TAKE THE TRAINING AND RECEIVE CONTINUING MEDICAL
EDUCATION CREDITS.
SO THAT'S REALLY WONDERFUL AND SUPER, SUPER SUCCESSFUL.
AND THEN FINALLY THE LAST AREA THAT I'LL ADDRESS IS THAT LAST SUMMER WE� ACTUALLY LAST SPRING
WE LAUNCHED A CALL FOR SUBMISSIONS FOR INDEPENDENT RESEARCHERS TO BE ABLE TO WRITE PROPOSALS,
FOCUSED ON USING DATA FROM OUR CHRONIC CONDITIONS WAREHOUSE.
CMS AS WELL AS OTHER FEDERAL AGENCIES HAVE SOME PROTECTED DATA THAT WE CAN ALLOW CERTAIN
RESEARCHERS TO HAVE WHAT WE CALL A SEAT AT THE TABLE TO BE ABLE TO ACCESS AND ANALYZE
DATA.
LAST YEAR WE HELD AN OPEN SUBMISSION TIME PERIOD AND WE SELECTED FIVE INVESTIGATORS
WHO ARE NOW ABOUT EIGHT MONTHS INTO WORKING WITH THE DATA THAT THEY HAVE SELECTED AND
IT RUNS THE GAMUT FROM SOME FOLKS WHO ARE LOOKING AT GENDER AND GENDER IDENTITY ISSUES,
TRYING TO TOUCH OFF SOME RESEARCH WE WERE WORKING ON, TO SOME OTHER FOLKS WHO ARE LOOKING
AT MATERNITY DISPARITIES, IN MATERNITY CARE CLAIMS.
SO WE'RE REALLY EXCITED ABOUT THIS AND WE'RE HOPING THAT AFTER THIS THREEYEAR CYCLE FINISHES
WE MIGHT BE ABLE TO OFFER THIS OPPORTUNITY TO SOME OTHER INVESTIGATORS IN THE FUTURE.
BUT ALSO THIS WILL BE A REALLY GREAT OPPORTUNITY FOR US TO GET MORE OF OUR MINORITY HEALTH
DATA OUT INTO THE WORLD USING MEDICARE CLAIMS.
SO THAT'S MY CONTACT INFORMATION, IF YOU HAVE ANY QUESTIONS.
AND IF THERE ARE ANY QUESTIONS THAT YOU HAVE NOW, I'M DELIGHTED TO ANSWER THEM FOR YOU.
[APPLAUSE]
>> ANY QUESTIONS IN THE ROOM?
YOU HAVE TO USE THE MICROPHONE.
I'LL BRING IT TO YOU.
>> HI.
THANK YOU, GREAT PRESENTATION.
I'M CURIOUS ABOUT YOU SHOWED A SLIDE WITH DATA WITH REALLY GOOD OUTCOMES FOR VACCINATIONS
AND HIV TESTING.
I'M CURIOUS ABOUT IF THERE HAVE BEEN OPPORTUNITIES TO USE THE SEXUAL AND GENDER MINORITY POPULATION
AS CASE STUDIES AND PULLING SORT OF THE BEST PRACTICES FROM THAT POPULATION TO MORE GENERALIZED
POPULATION OR HETEROSEXUAL, ET CETERA.
>> GOSH, I DON'T KNOW.
SO NOT NECESSARILY FROM OUR RESEARCH, BUT I DO KNOW THAT AT CDC THEY DO A LOT OF TARGETED
WORK AROUND USING SOME OF THE CAMPAIGNS THAT HAVE WORKED IN SEXUAL AND GENDER MINORITY
POPULATIONS AND SEEING IF THERE ARE SOME TRANSLATABLE OUTCOMES FROM THAT.
I THINK ONE OF THE THINGS THAT HAS BEEN IDENTIFIED IS THAT HAVING HIGHLY TARGETED AND POPULATIONSPECIFIC
CAMPAIGNS IS REALLY USEFUL.
I KNOW AROUND SOME OF THE VACCINE AND ESPECIALLY LIKE SMOKING CESSATION CAMPAIGNS, WORKING
WITH A PARTICULAR COMMUNITY HEALTH ADVISER, OR COMMUNITY MEMBER WHO MIGHT BE PART OF A
PARTICULAR IMMIGRANT OR MINORITY POPULATION WITHIN A COMMUNITY, I KNOW THAT IN CERTAIN
POCKETS OF SAN FRANCISCO THEY ENLIST COMMUNITY HEALTH WORKERS TO REALLY WORK WITH THEM ON
KNOWING THE POPULATION, IN ORDER TO DESIGN AN EFFECTIVE INTERVENTION FOR THOSE THINGS.
BUT THAT'S KIND OF BEYOND THE SCOPE OF WHAT WE'RE DOING.
>> I GUESS GOING DOWN THE SAME PATH HAVE YOU GUYS EXTRAPOLATED THAT INTO MAYBE OPIOID USE?
>> YES.
SO WE HAVE NOT YET, THAT IS SOMETHING THAT OUR OFFICE OVERALL IS STARTING TO REALLY PAY
A LOT MORE ATTENTION TO. AND I DON'T KNOW WHAT OUR PLANS ARE CURRENTLY
FOR THAT, BUT WE HAVE STARTED DISCUSSIONS ABOUT HOW WE'RE GOING TO BETTER TURN OUR ATTENTION
TO THAT.
YES.
>> YOU HAVE A MIC ON THE TABLE.
>> SO I KNOW PEOPLE ARE REALLY EXCITED WHEN THE MEDICARE BENEFICIARY STUDY CAME OUT, METHODOLOGY
FOR SORT OF FINDING TRANS PEOPLE.
TWOPART QUESTION.
ONE IS CAN YOU TALK ABOUT THE DIFFERENCES THAT WE'VE SEEN IN THE SIZE OF THE SAMPLE
YOU WERE ABLE TO FIND THROUGH FOR EXAMPLE SMALLER SAMPLE SIZES WHEN PEOPLE HAVE ACTUALLY
BEEN RESPONDENTS AND ANY THOUGHTS YOU HAVE ON WHY THERE'S SUCH A SIGNIFICANT DIFFERENCE?
THAT'S PART ONE.
PART TWO IS HAS THERE BEEN THE KIND OF UPTAKE OF THE RESEARCH THAT YOU THOUGHT THAT WOULD
BE IN TERMS OF PEOPLE SAYING NOW WE KNOW THIS ABOUT OLDER ADULT TRANS POPULATIONS, COMORBID
CONDITIONS, HERE IS WHAT WE'RE GOING TO DO, OR ARE PEOPLE SITTING AND NOT TAKING ACTION
ON IT YET?
>> BOTH REALLY GREAT QUESTIONS.
WHAT WAS THE FIRST ONE AGAIN?
OH, SAMPLE SIZE DIFFERENCES, YES.
YOU KNOW, THAT'S REALLY GREAT.
I THINK LIKE I SAID, WORKING WITH CLAIMS DATA IS VERY DIFFERENT FROM WORKING WITH SURVEY
DATA, IN THAT WE ARE MAKING A LOT OF ASSUMPTION BASED ON ICD9 CODES ASSOCIATED WITH SOMEBODY'S
CLAIMS DATA AND DON'T NECESSARILY HAVE A WAY YET TO FOLLOW UP WITH THAT INDIVIDUAL AND
GET A CONFIRMATION OF, YES, I IDENTIFY AS BEING TRANS OR NO, I DON'T IDENTIFY AS BEING
TRANS.
SOME OF THE WORK WE'RE DOING RIGHT NOW IS TRYING TO BETTER UNDERSTAND THE POPULATION
THAT WE'VE IDENTIFIED, AND LOOKING AT SPECIFICALLY WHAT KIND OF HORMONES THEY ARE ON AND SEEING
IF THERE COULD HAVE BEEN A CODING ERROR OR IF THEY ARE ON PARTICULAR HORMONE FOR A DIFFERENT
REASON BECAUSE OBVIOUSLY SOME MASCULINIZING OR FEMINIZING HORMONES ARE SOMETIMES ADMINISTERED
FOR OTHER HEALTH REASONS.
SO WE'RE TRYING TO BETTER EXPLORE THAT.
AND ALSO LOOKING FOR OPPORTUNITIES WHERE WE COULD DEVELOP A WAY TO CONTACT THOSE BENEFICIARIES
THAT WE'VE IDENTIFIED, AND FOLLOW UP WITH THEM BECAUSE THAT WOULD BE LIKE THE GOLD STANDARD
OF BEING ABLE TO VERIFY THAT OUR POPULATION AND OUR ALGORITHM ARE ACTUALLY WORKING.
YOU KNOW, I THINK ONE OF THE ISSUES IN SAMPLE SIZE IS THAT LIKE WITH THE CLAIMS DATA, THEY
ARE NOT GIVEN THE OPTION OF NONDISCLOSURE.
AND THAT'S SOMETHING THAT EVERYONE HAS THE OPTION OF IF YOU'RE FILLING OUT A SURVEY OR
IF YOU'RE ASKED TO PARTICIPATE IN INPERSON OR COMPUTERIZED RESEARCH IN SOME WAY.
AND SO I WANT TO BE RESPECTFUL AND SAY THAT COULD BE VERY PROBLEMATIC IN SOME WAYS.
BECAUSE WE'RE NOW LABELING THEM AS IDENTIFYING AS A WAY WE DON'T HAVE ANY WAY OF CONFIRMING.
HOWEVER, WE ARE ABLE TO SEE THAT THIS IS A MUCH MORE PREVALENT POPULATION THAN A LOT
OF PEOPLE HAVE OTHERWISE SPECULATED.
AND THAT MEANS THAT WE CAN NOW SAY WE NEED TO BE CONCERNED ABOUT MAKING SURE THAT THEY
ARE GETTING THE HIGHEST QUALITY CARE AS MEDICARE BENEFICIARIES.
SO I THINK THAT'S PROBABLY THE BEST CASE, AND THEN THE SECOND PART OF YOUR QUESTION
>> RESEARCH UPDATE.
>> RESEARCH UPDATE.
RIGHT NOW WE'RE WORKING ON� LIKE I SAID, WE EXPANDED OUR INITIAL ALGORITHM FROM ONE
YEAR OF DATA TO FIVE YEARS OF DATA.
AND NOW WE HAVE ABOUT 10,000 INDIVIDUAL BENEFICIARIES, WE WENT THROUGH THIS PROCESS WHERE WE MADE
SURE THAT WE DIDN'T HAVE ANY REPEAT BENEFICIARIES, AND IN SOME CASES CAN TRACK BENEFICIARIES
OVER A NUMBER OF YEARS.
SOME OF THEM ENTER AND EXIT THE MEDICARE SYSTEM, WHICH IS ALSO REALLY� THERE'S SO MANY INTERESTING
RESEARCH QUESTIONS HERE, IT'S NOT EVEN FUNNY.
BUT WHAT WE JUST FINISHED WORKING ON THAT WILL BE PRESENTING AT THE JOINT STATISTICAL
MEETING THIS SUMMER IS MATCHED COHORT ANALYSIS, SO MATCHING TRANS AND CIS, NONTRANS INDIVIDUALS
OF A SIMILAR AGE MEDICARE ENTITLEMENT STATUS SO IF THEY QUALIFIED VIA AGE THEN WE MATCH
THEM ON BEING AGED IN MEDICARE BENEFICIARY VERSUS DISABILITY QUALIFYING MEDICARE BENEFICIARY.
AND I THINK THERE'S ONE OTHER THING THAT WE HAD MATCHED ON.
BUT I DON'T REMEMBER WHAT IT IS AT THE MOMENT.
AND SO THAT'S REALLY INTERESTING.
AND FROM THAT WE'RE TRYING TO LOOK AT DIFFERENCES BETWEEN THE TRANS BENNIES AND CIS BENNIES
AND HORMONAL USE, WE PUT TOGETHER IN DEPTH ANALYSIS OF CHRONIC CONDITIONS, I KNOW THERE
HAVE BEEN A LOT OF SMALLER CONVENIENCE SAMPLES THAT LOOKED AT THE LONGTERM EFFECTS OF HORMONE
USE FOR TRANS FOLKS, AND THAT'S SOMETHING THAT HOPEFULLY NIH WILL BE SPONSORING MORE
RESEARCH ON SO THAT WE CAN HAVE LIKE A COUPLE DIFFERENT FRONTS, BUT LIKE IT IS� HAS BEEN
A CONCERN BECAUSE TRANS POPULATIONS HAVEN'T BEEN INCLUDED IN THAT BASIC SCIENCE LEVEL
RESEARCH IN THE PAST.
DID YOU HAVE ANOTHER QUESTION?
>> YEAH, I DID.
YOU HAD ANOTHER SLIDE THAT SHOWED OLDER ADULTS, 85+, TRANS.
YES.
>> THAT ONE. 1.2% RIGHT NOW, I'M CURIOUS WHERE CAN WE FIND
OUT MORE INFORMATION, CLAIMS DATA OR POLICY BRIEFS, THAT'S PROBABLY NOT THE RIGHT TERM
BUT THAT YOU'RE PUTTING OUT, MORE WE COULD LEARN?
>> WE DON'T HAVE ANYTHING UP YET.
STAY TUNED.
I THINK IN THE RESEARCH ARENA, THE 85+ CROWD IS BEING CALLED LIKE THE OLDEST OLD, WHICH
IS A POPULATION THAT IS EXPANDING BECAUSE WE HAVE SUCH EXCELLENT HEALTH CARE AND, YOU
KNOW, PEOPLE'S QUALITY OF LIFE IS GENERALLY RISING IN OUR COUNTRY.
SO WE'RE GETTING A MORE ROBUST OLDER ADULT POPULATION TO LOOK AT.
MOST TRANS BENNIE RESEARCH, THEY QUALIFY THROUGH DISABILITY PATHWAY, GENERALLY AGE 20 THROUGH
WHATEVER OUR ENDPOINT IS, BUT STAY TUNED, HOPEFULLY WE'LL HAVE SOMETHING OUT EVENTUALLY.
>> THANK YOU.
>> YES, RIGHT BEHIND YOU.
>> ONE MORE.
I THINK IT'S REALLY COOL YOU'RE ABLE TO GET THIS KIND OF INFORMATION FROM CLAIMS.
WITH WHAT YOU SAID, LIKE SOMETIMES YOU HAVE TO MAKE ASSUMPTIONS, WOULD YOU ASSUME THERE
ARE MORE PEOPLE WHO IDENTIFY AS GAY, LESBIAN AND BISEXUAL THAN WE'RE GETTING FROM THIS
DATA?
>> WELL, SO THIS DATA IS ONLY ON TRANS BENNIES.
THERE'S NOT ICD9 CODES TO FIND OUT IF SOMEBODY IS GAY, LESBIAN OR BISEXUAL, WE NEED TO HAVE
A SELF REPORTED VARIABLE ON INTAKE FORMS OR SOMETHING THAT WOULD WORK ITS WAY THROUGH
ELECTRONIC HEALTH RECORDS OR THROUGH A SURVEY THEY WOULD TAKE.
BUT, YOU KNOW, I THINK A LOT OF IT HAS TO DO WITH VISIBILITY.
I'VE MET A COUPLE CLINICIANS WHO SAY, YOU KNOW, I DON'T HAVE ANY LGBT PATIENTS, I WAS
LIKE, WELL, HAVE YOU ASKED THEM?
BECAUSE, YOU KNOW, IT'S LIKE I SAID, WE HAVE A HISTORY OF NONDISCLOSURE IN OUR COUNTRY
BECAUSE PEOPLE HAVE BEEN AFRAID OF DISCRIMINATION OR HARASSMENT, NOT BEING ABLE TO ACCESS THE
CARE THAT THEY NEED.
SO THOSE KIND OF FACTORS WEIGH HEAVILY ON WHETHER OR NOT SOMEBODY IS WILLING TO STEP
FORWARD AND DISCLOSE SOMETHING THAT THEY FEEL IS REALLY PERSONAL, AND IT IS REALLY PERSONAL.
BUT IT'S ALSO SOMETHING THAT CAN INFLUENCE WHETHER OR NOT YOU ARE GETTING THE APPROPRIATE
HEALTH CARE, PREVENTIVE SERVICES AND SCREENINGS THAT SOMEBODY NEEDS TO BE GETTING.
THANKS FOR YOUR QUESTIONS.
ANYBODY ELSE?
NO?
>> WELL, THANK YOU VERY MUCH, CHRISTINA, FOR YOUR PRESENTATION.
LET'S GIVE HER ANOTHER HAND.
[APPLAUSE] WE'RE MOVING AHEAD OF OUR SCHEDULE BUT WE'LL
GO AHEAD AND TURN IT OVER TO ELLIOTT KENNEDY NOW.
>> THANK YOU VERY MUCH.
OKAY.
THAT IS QUITE SMALL.
IT'S A PLEASURE TO PRESENT WITH THE TWO OF YOU AND HEAR THE WORK YOU'RE DOING.
CHRISTINA'S POINTS, IT'S INCREDIBLE HOW FAR WE'VE COME AND HOW SPECIFIC WE GET ON THE
WORK WE'RE DOING.
FROM THE TWO OF THEM YOU HEARD A LOT ABOUT HOW WE'RE WORKING TO LEARN MORE ABOUT THE
HEALTH OF LGBT POPULATIONS, I STILL USE LGBT BECAUSE I USE THE LANGUAGE THE STAKEHOLDERS
WE MEET WITH USE AND PEOPLE DON'T SEE THEMSELVES AS SEXUAL AND GENDER MINORITIES BUT PART OF
LGBT COMMUNITY.
I THINK ONE THING TO NOTICE ACROSS THE DEPARTMENT WE USE DIFFERENT ACRONYMS FOR DIFFERENT REASONS,
WE USE LGBTQ, TWO SPIRIT, TWO S, SEXUAL AND GENDER MINORITY FOR CLINICAL RESEARCH MAKES
SENSE TO ME.
BRIEF CAVEAT.
I'M GOING TO GIVE BRIEF AND BROAD HISTORICAL SKETCH HOW WE TAKE WHAT WE KNOW ABOUT DISPARITIES
IN LGBT HEALTH AND TURN IT TO ACTION TO MITIGATE AND HOW WE ORGANIZED AS A DEPARTMENT AROUND
THIS ISSUE.
SO WE OFTEN START TALKING ABOUT THIS WORK, THIS ORGANIZATION OF THIS WORK, IN 2010, WHICH
IS WHEN THE LGBT ISSUES COORDINATING COMMITTEE WAS CREATED.
I DO WANT TO MENTION BEFORE 2010 PEOPLE ACROSS THE DEPARTMENT WERE INTEGRATING LGBT WORK
INTO EVERYDAY LIVES.
I HAVE IN MY OFFICE A DRAFT BRIEFING FROM HHS EMPLOYEES AS RECOMMENDATIONS TO THE CLINTON
ADMINISTRATION ON THINGS THAT THIS DEPARTMENT COULD DO TO IMPROVE HEALTH AND WELL BEING
OF LGBT POPULATIONS.
SO I WANT TO START BY SAYING THANK YOU TO THE PEOPLE WHO ARE WATCHING, PEOPLE IN THE
ROOM, PEOPLE ACROSS THE DEPARTMENT FORTUNATE LIKE US TO HAVE LGBT ISSUES AS A PART OF THEIR
JOB DESCRIPTION, BUT THERE ARE MANY, MANY MORE PEOPLE WHO JUST ARE GRANTS OFFICERS,
PROVIDING TRAINING, DRAFTING POLICY, WHO INCORPORATE LGBT ISSUES INTO THEIR EVERYDAY WORK, AND
THAT'S THE WAY IT SHOULD BE.
LGBT POPULATIONS SHOULD HAVE EQUAL ACCESS TO THE WORK WE'RE DOING.
SO THANK YOU.
HAPPY PRIDE.
SO BACK TO 2010, IN 2010 THERE'S AN EXECUTIVE ORDER FROM PRESIDENT OBAMA REQUIRING THAT
PARTNERS BE ABLE TO ACCESS THEIR FAMILIES WHEN IN THE HOSPITAL, HOSPITAL VISITATION
AND LGBT COUPLES HAVE AVAILABILITY TO ADVANCE DIRECTIVES IN WORSE CASE SCENARIOS.
THERE WAS A THIRD REQUEST OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, THAT SECRETARY
SEBELIUS ESTABLISHED SOME MECHANISM OF PROVIDING ADDITIONAL RECOMMENDATIONS TO THE PRESIDENT
ABOUT ACTIONS THAT THIS DEPARTMENT COULD TAKE TO ADVANCE LGBT HEALTH AND WELL BEING.
SO WHAT THE SECRETARY DID WAS ESTABLISH THIS COORDINATING COMMITTEE WHICH I'LL TALK ABOUT
MORE IN A MINUTE.
THROUGH THE STRUCTURE OF THE COORDINATING COMMITTEE, HHS HAS WORKED COLLABORATIVELY
SINCE THEN AND THIS IS JUST BRIEF TIME LINE.
EVERY YEAR THE COORDINATING COMMITTEE PUBLISHED AN ANNUAL REPORT, HHS.GOV/LGBT, YOU WITH FIND
SPECIFICS WE'VE TAKEN IN THIS AREA.
WE'VE MET AT LEAST ONCE EVERY YEAR WITH LGBT STAKEHOLDERS TO ACTUALLY WORK WITH THE COMMUNITY
TO UNDERSTAND THEIR CONCERNS AND TO DEVELOP SOLUTIONS THAT WORK FOR ALL PARTIES.
2015 SKIPPING AHEAD WE ESTABLISHED NIH SEXUAL AND GENDER MINORITY RESEARCH OFFICE THE FIRST
TIME THAT WE HEARD LOUD AND CLEAR THAT WE SEARCH AND DATA ARE THE CORNERSTONE OF BEING
ABLE TO MAKE LIKE EVIDENCEBASED INFORMED POLICY DECISIONS.
SO THAT AND THE DESIGNATION OF HEALTH DISPARITIES POPULATION WERE TWO OF THE HIGHEST HANGING
FRUIT THAT WE HAD HAD, SO JUST CALLING THAT OUT.
WE MADE A LOT OF PROGRESS PARTICULARLY THE LAST SEVERAL YEARS AROUND DATA COLLECTION,
BY THIS POINT A ROTE STATEMENT IF YOU'RE NOT COUNTED YOU DON'T COUNT.
WE PUT TOGETHER GUIDANCE, LGBT SUBGROUP ENCOURAGING COLLECTING DATA AND STANDARDIZED QUESTIONS,
IMPORTANTLY INCREDIBLE FOUNDATION TO MAKING THIS JUST BE NORMALIZED WORK.
LAST YEAR WE CREATED SENIOR ADVISER FOR LGBT HEALTH POSITION, MY POSITION.
AND THE GOAL BEHIND THAT WAS TO CREATE ONE SORT OF POINT OF COORDINATION AND COLLABORATION
ACROSS THE DEPARTMENT, SO MAKE SURE LGBT WORK CAN BE INTEGRATED ACROSS THE DEPARTMENT.
I'M NEVER SURE HOW FAMILIAR PEOPLE ARE WITH THE WAY THE COMMITTEE WORKS.
IT JUST EXISTS AS AN ENTITY.
SO REPRESENTATIVES FROM EACH STAFF DIVISION AND OFFICE DIVISION MEET ON A MONTHLY BASIS,
TRADITIONALLY PEOPLE APPOINTED BY THE PRINCIPALS OF THEIR DIVISION AND HAD SOME CONNECTION
TO LGBT POLICY WORK, NOT ALWAYS THE CASE BUT THE IDEA WAS LET'S CONVENE A GROUP OF PEOPLE
WHO ARE EXPERTS IN THE FIELD OR INTERESTED IN THE FIELD, BUT WHO HAVE A VESTED INTEREST
IN MAKING SURE WE'RE COLLABORATING, CMS AND OFFICE OF CIVIL RIGHTS TALKED ABOUT LGBT SPECIFIC
CIVIL RIGHTS ISSUES, FOR EXAMPLE.
WE'RE LED TYPICALLY BY SENIOR COCHAIRS SO FOR MANY YEARS IT WAS KATHY GREENLY, CURRENTLY
EDWIN WALKER, DEPUTY ASSISTANT AT ACL AND BRIAN ALTMAN, AT SAMHSA.
RECENTLY DR.
JOEL MULLEN.
AND THE COMMITTEE MEETINGS ARE A FORUM FOR SHARING INFORMATION AN BEST PRACTICES AND
FACILITATING COLLABORATION.
SO I WANT TO SHIFT GEARS BRIEFLY AND GOING THROUGH THIS QUICKLY TALK ABOUT THE DIFFERENT
BUCKETS OF WORK WE DO AND I'LL GIVE SOME SPECIFICS BUT I WOULD AGAIN POINT YOU TO OUR ANNUAL
REPORTS WHICH WILL GIVE YOU MORE INFORMATION THAN YOU NEED ABOUT EVERYTHING WE'VE EVER
DONE IN THIS AREA.
SO ONE OF THE MAJOR THINGS WE'VE DONE IS ACKNOWLEDGE THAT STRUCTURAL BARRIERS HAVE BEEN ONE OF
THE LARGEST DRIVERS IN NEGATIVE HEALTH OUTCOMES FOR YOUR COMMUNITY, WHETHER LACK OF ACCESS
TO HEALTH CARE OR LACK OF PROVIDERS WHO UNDERSTAND SPECIFIC NEEDS OF LGBT INDIVIDUALS, IF IT'S
SOCIAL SERVICE ORGANIZATIONS TURNING AWAY LGBT PEOPLE BECAUSE OF LACK OF UNDERSTANDING
OF THE COMMUNITY, ONE OF THE FIRST THING THE COORDINATING COMMITTEE WANTED TO DO IS EVERYTHING
THAT WE COULD TO REDUCE THE STRUCTURAL BARRIERS BY PROHIBITING DISCRIMINATION.
SO I THINK MANY PEOPLE ARE PROBABLY FAMILIAR WITH SECTION 1557 OF THE AFFORDABLE CARE ACT
WHICH WE'RE ENJOINED PRESENTLY FROM ENFORCING, DISCRIMINATION IN HEALTH CARE, SOMETHING PEOPLE
ARE LESS FAMILIAR WITH IS WHERE WE STARTED WHICH IS WHAT WE CALL THE RATE OF NONDISCRIMINATION,
ONE PROHIBIT EMPLOYEES FROM DISCRIMINATING, ONE PROHIBITS CONTRACTORS FROM DISCRIMINATING
AND LAST YEAR WE FINALIZED OUR RULE THAT PROHIBITS DISCRETIONARY GRANTEES FROM DISCRIMINATING
IN PROVISIONAL SERVICES.
OR REGULATIONS, CMS HAS SEVERAL SPECIFIC ONES THAT MENTION SEXUAL ORIENTATION AND GENDER
IDENTITY IN STATUTE.
THIS SEEMS SMALL, BUT MADE A DIFFERENCE TO TRANSGENDER PEOPLE, WE ISSUED IN 2014 FREQUENTLY
ASKED QUESTIONS, CLARIFYING PREVENTIVE IT WAS AVAILABLE UNDER THE AFFORDABLE CARE ACT
ARE AVAILABLE TO TRANSGENDER PEOPLE AND MEDICALLY APPROPRIATE, COMING UP SIGNIFICANTLY FOR TRANSGENDER
MEN IN NEED OF PREVENTIVE SERVICES WHO COULDN'T ACCESS BECAUSE THEY WERE THOUGHT OF AS WOMEN'S
SERVICES.
(INDISCERNIBLE) WOULD HAVE CHANGED MEDICARE AND MEDICAID PARTICIPATING CONDITIONS OF PARTICIPATION
ON THE BASIS OF IDENTITY.
IT'S INTERESTING TO ME HOW MANY DIFFERENT THINGS THIS DEPARTMENT DOES THAT HAVEN'T BEEN
FULLY INCLUSIVE OF TRANSGENDER PEOPLE OR LGBT PEOPLE BROADLY.
ANOTHER THING, WE CLARIFIED THE NATIONAL BREAST AND CERVICAL CANCER EARLY DETECTION PROGRAM
WAS ALSO AVAILABLE TO TRANSGENDER WOMEN FOR WHOM IT WAS MEDICALLY APPROPRIATE, AGAIN MAKES
A HUGE DIFFERENCE IN THIS COMMUNITY BUT JUST NOT SOMETHING PEOPLE WERE THINKING ABOUT WHEN
THEY PASSED THE PROGRAM.
THEY FOCUSED ON NONDISCRIMINATION.
WE'VE FOCUSED ON (INDISCERNIBLE).
THESE ARE MOST OF THE MAJOR SURVEYS WHERE WE'VE ADDED SEXUAL ORIENTATION QUESTIONS.
WE'VE NOT BEEN AS SUCCESSFUL ADDING GENDER IDENTITY QUESTIONS BUT IT HAS REMAINED A TOP
PRIORITY.
I WANT TO CALL OUT HERE THE NATIONAL SURVEY ON DRUG USE AND HEALTH IN THE LAST 12 MONTHS,
THE FIRST YEAR WE'VE BEEN ABLE TO REPORT INFORMATION.
THIS MIMICKED THE YOUTH RISK BEHAVIORAL SYSTEMS ALSO, ACROSS EVERY SINGLE SUBSTANCE SURVEYED,
LGBT PEOPLE WERE DISPROPORTIONATELY LIKELY TO USE.
I COULD BE WRONG BUT I BELIEVE WE'RE THE ONLY POPULATION SURVEY FOR WHICH THAT'S TRUE, EVERY
OTHER SUBSTANCE ARE HIGHER USAGE RATES.
I WANT TO THANK CHRISTINA AND KAREN FOR THESE CONTINUED INVOLVEMENT IN SUBGROUPS RELATED
TO LGBT RESEARCH AND DATA COLLECTION.
AND THEN WE HAVE OBJECTIVES IN THE HEALTHY PEOPLE 2020, OUR OBJECTIVES IN HEALTHY PEOPLE
2020 ARE TO COLLECT DATA, HOW IMPORTANT IT IS TO DO THAT.
SO USUALLY I TALK ABOUT THIS AS EDUCATION AND DEVELOPING CULTURAL COMPETENCE.
THEY BOTH FALL UNDER PATIENTCENTERED CARE.
WE SUPPORT PROVIDERS BEST SERVING LGBT INDIVIDUALS WHERE MOST OF THE WORK ACROSS THE DEPARTMENT
IS.
PEOPLE DEVELOP RESOURCES, SUPPORT TRAINING CENTERS, AND GOING THROUGH THEM INDIVIDUALLY
IN I BELIEVE 2014 PUBLISHED ENDING CONVERSION THERAPY, WE HAVE I THINK DISTRIBUTED OVER
10,000 COPIES OF THIS, AND IT IS AVAILABLE FOR FREE ONLINE, THE FIRST REPORT ON CONVERSION
THERAPY, MOST SPECIFICALLY ON DEVELOPMENT OF SEXUAL ORIENTATION AND GENDER IDENTITY,
A RESOURCE FOR PROVIDERS AND FOR FAMILIES, EDUCATORS, FOLKS WHO ARE SEEKING HOW TO SUPPORT
LGBT YOUTH IN HEALTHY WAYS.
CREATING AND WELCOMING A PROGRAM ONE BY ACS, ANOTHER RESOURCE UNDERSTANDING LGBTQ YOUTH,
TEEN PREGNANCY PROGRAMS.
SOMETHING SURPRISING TO ME, FOR LESBIAN, GAY AND BISEXUAL WOMEN, LIKE TEENAGERS, IT'S SOMETHING
LIKE 7 TO 11 TIMES MORE LIKELY TO HAVE AN UNINTENDED PREGNANCY.
AND FINALLY IN THE LAST SEVERAL YEARS THREE� AT LEAST THREE DEDICATED TRAINING AND TECHNICAL
ASSISTANCE CENTERS, HEARTLAND ALLIANCE ON LGBT REFUGEES THROUGH FENWAY AND HRSA, WE
SUPPORT LGBT HEALTH PROVIDER NETWORK AND SAGE PARTNERED WITH ACL, AN OLDER ADULT EDUCATION.
THAT'S MY BRIEF OVERVIEW.
I'M HAPPY TO ANSWER QUESTIONS IF PEOPLE HAVE SPECIFIC QUESTIONS ON THINGS WE'VE DONE OVER
THE LAST FEW YEARS, MORE OF AN UNDERSTANDING HOW WE ORGANIZE THIS WORK.
NO QUESTIONS?
GREAT.
THANK YOU.
[APPLAUSE]
>> WE'D LIKE TO THANK ALL OF OUR SPEAKERS THIS AFTERNOON FOR ALL OF THE INFORMATION
THAT THEY HAVE PROVIDED.
AND ONCE AGAIN, YOU WILL BE ABLE TO VIEW THE PRESENTATION ONLINE.
WE'LL MAKE THE LINKS AVAILABLE TO YOU.
ALSO, THE SLIDES WILL BE A PART OF IT. AND IF YOU ARE SVP ON OUR MAX.GOV PAGE, THE
SLIDES HAVE ALREADY BEEN DOWNLOADED, BUT THE LIVE STREAMING INFORMATION, LIKE I SAID, WILL
BE PROVIDED TO YOU BECAUSE YOU ARE NOW ON OUR MAILING LIST FOR THE DIVERSITY AND INCLUSION
DIVISION.
AND YOU'LL BE ON OUR MAILING LIST UNTIL SUCH TIME AS YOU SEND US AN EMAIL AND SAY TAKE
ME OFF.
RIGHT NOW, OUR EMAIL LIST CONSISTS OF OVER 1300 INDIVIDUALS WHO HAVE TAKEN PART IN VARIOUS
PROGRAMS AND ACTIVITIES THAT WE HAVE SPONSORED.
AND WE DECIDED TO JUST AUTOMATICALLY DOWNLOAD PEOPLE TO THE LISTSERV BASED ON THE FACT THAT
HAVING ATTENDED WHATEVER WE HAVE DONE, THEY HAVE EVIDENCED THEIR INTEREST AND SUPPORT
IN FUTURE ACTIVITIES, AS FAR AS WE'RE CONCERNED.
SO WE HAVE A REAL NICE GROUP OF FOLKS WHO GET EMAILS FROM US, AT LEAST ONCE WEEKLY,
BUT SOMETIMES TWO OR THREE TIMES A WEEK, ABOUT DIFFERENT THINGS.
AND I WANTED TO LET YOU KNOW THAT THIS MONTH BEING LGBT PRIDE MONTH, WE HAVE DEDICATED
ALL OF OUR ARTICLES FOR THE DIVERSITY AND INCLUSION VIRTUAL EXCHANGE SERIES TO LGBTRELATED
TOPICS.
SO WE INVITE YOU TO GO AGAIN TO THE MAX.GOV PAGE, IF YOU DON'T HAVE AN ACCOUNT WE HAVE
A WAY THAT WE CAN GIVE YOU INFORMATION FOR SETTING THAT ACCOUNT UP.
AND YOU'LL HAVE THE WHOLE FEDERAL GOVERNMENT OPEN TO YOU AT YOUR FINGERTIPS, TO KEEP TRACK
OF A LOT OF DIFFERENT THINGS, A WEALTH OF INFORMATION AVAILABLE TO YOU THROUGH THAT.
AND YOUR DIVERSITY AND INCLUSION DIVISION MAKES FULL USE OF THE AVAILABILITY OF THAT
MAX.GOV SITE WITH ALL OF THE INFORMATION CONCERNING OUR EVENTS AND ACTIVITIES.
SO ONCE AGAIN, WE INVITE YOU TO GO TO DIVERSITY@HHS.GOV, SEND AN EMAIL.
IF YOU NEED ASSISTANCE OR INFORMATION IN SETTING UP THE MAX.GOV PAGE OR EXTRACTING INFORMATION
CONCERNING DIVERSITY AND INCLUSION ACTIVITIES, WE TRY TO MAKE IT A POINT TO HAVE ALL OF THOSE
LINKS AVAILABLE TO YOU THROUGH OUR ANNOUNCEMENTS.
ALSO FOR TODAY WE DO HAVE AN EVALUATION LINK, SO WE ASK YOU TO GO TO THAT, TO EVALUATE TODAY'S
SESSION, AND GIVE US SOME FEEDBACK ON HOW VALUABLE THE SESSION HAS BEEN TO YOU.
I THINK THAT WE REALLY DID HAVE THE BEST OF THE BEST IN HHS ON THIS TOPIC, PAR EXCELLENCE
PANEL, SO WE WANT TO THANK YOU ONCE AGAIN FOR BEING AVAILABLE, FOR BEING WILLING, FOR
SHARING THE INFORMATION, AND WE JUST ARE SO HAPPY THAT THIS IS A SCENARIO IN WHICH WE'RE
ABLE TO HAVE ON DEMAND AVAILABILITY LATER BECAUSE, YOU KNOW, JUST ONE SHOT AT SOMETHING
DOESN'T WORK ANYMORE.
YOU HAVE TO BE ABLE TO SEE SOMETHING AND YOU CAN SHARE THIS INFORMATION WITH EVERYBODY
YOU KNOW THAT THEY CAN BENEFIT FROM IT, NOT BECAUSE THEY MISSED IT TODAY BUT THEY CAN
BENEFIT JUST THE SAME AND WE DID APPRECIATE HHS STUDIO AND ALL OF THE STAFF, KAREN, MORGAN,
MIKE, EVERYBODY, WHO HAS ASSISTED US IN DOING THE LIVE STREAMING TODAY.
I WANT TO ALSO THANK SONYA KEITH OF MY OFFICE WHO HAS BEEN RESPONSIBLE FOR DOING THE LOGISTICAL
WORK, ASSOCIATED WITH TODAY'S EVENT, AS WELL AS THE DIVERSITY AND INCLUSION DIVISION, INSTRUMENTAL
IN HELPING US WITH THE COMMUNICATIONS PIECE OF TODAY'S EVENT.
AND I'D ALSO LIKE TO REMIND YOU JUST ONCE AGAIN ABOUT THE UPCOMING SESSION NEXT WEDNESDAY,
JUNE�21, HHS NONDISCRIMINATION AND INCLUSION POLICY AND PROCEDURES RELATING TO TRANSGENDER
EMPLOYEES AND APPLICANTS WHICH WILL BE PRESENTED BY CYNTHIA RICHARDSON CROOKS, DIRECTOR OF
THE EEO COMPLIANCE AND OPERATIONS DIVISION.
NOW, IF THERE ARE NO FURTHER QUESTIONS OR COMMENTS, AS THEY SAY ON COURTTV, WE STAND
ADJOURNED.
THANK YOU.
[APPLAUSE]
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