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PRIDE In All Who Served

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PRIDE In All Who Served is a health promotion group that was designed and refined using human-centered design principles at the Hampton VA Medical Center in 2016. Each one-hour session of the ten-week, manualized, closed group provides an opportunity to connect with other LGBTQ+ Veterans to build a peer support system while improving LGBTQ+ patient health literacy. Connection to social support is a protective factor against suicide, stigma-related stress and other health outcomes for LGBTQ+ individuals. The group facilitation manual provides a comprehensive approach to implementation of the service, staff training, and guidance on how to create a welcoming environment. Veteran reactions to the service include: "I can't believe this group is at the VA!", "My life has gotten better by coming", and "I love this group! I feel better talking to my providers."

This innovation is scaling widely with the support of national stakeholders. See more scaling innovations.

Origin:

January 2016, Hampton VA Medical Center

Awards and Recognition:

iNET Seed Investee, iNET Spread Investee, Diffusion of Excellence National Diffusion Practice, Diffusion of Excellence Promising Practice

Partners:

Diffusion of Excellence, Health Equity, LGBTQ+ Health Program, Mental Health and Suicide Prevention, VHA Innovators Network

Tags:

Access to Care Coordinated Care Diversity, Equity, and Inclusion Health Equity High Reliability LGBTQ+ Health Mental Health Outpatient Care Primary Care Rural Health
Contact Team

Overview

Problem

LGBTQ+ Veterans are at an increased risk for suicide and other health care inequities, due in part to discrimination and barriers to accessing care. Despite provider-focused education and inclusive policies, a gap in clinical services for LGBTQ+ Veterans remains.

Videos

American Legion National Security Commission Chairman Matthew Shuman is featured in a Veteran's Health Administration's Office of Healthcare Innovation & Learning video promoting VA healthcare in the LGBTQIA+ community.

Links

Solution

The PRIDE in All Who Served program was developed to fill this critical care gap and to provide a resource for reducing healthcare disparities, including suicide risk. Session content focuses on overall wellness, increasing social connectedness, and empowering Veterans to engage in services related to their personal healthcare needs.

A PRIDE in All Who S ... See more

Images

PRIDE Facilitator Manual, V.3, published June 2024

Results

Veteran-reported outcomes are tracked before and after attending the group, with significant improvements including:
- increased protective factors (e.g., community involvement, identity certainty)
- reduced likelihood of attempting suicide in the future
- reduced symptoms of depression, anxiety, and concern about not being accepted

Images

Numbers snapshot (2018-2021)

Example Results from Veterans (2108-2021)

Example Results (Item from Brief Suicide-Related Behavior Questionnaire, SBQ-R; 2018-2021)

Metrics

  • Reach of Program = Improved access to affirmative care services for LGBTQ+ Veterans and rural LGBTQ+ Veterans;
  • Effectiveness of Program = Improved identity-related protective factors (e.g., identity acceptance, reduced internalized stigma)
  • Effectiveness of Program = Reduced symptoms of distress (e.g., symptoms of depression and anxiety)
  • Effectiveness of Program = Reduced suicide risk (e.g., reported likelihood of attempting suicide in the future)
  • Adoption, Implementation, Maintenance = Number of VA Facilities and Clinical Resource Hubs Consistently Offering PRIDE in All Who Served

Multimedia

Videos

PRIDE Awareness Month, June 2021

PRIDE Awareness Month, June 2021

PRIDE Awareness Month, June 2021

PRIDE In All Who Served iEX Talk, October 2021

Presentation for US Professional Association for Transgender Health, November 2023

Implementation

Timeline

  • Pre-Implementation
    1. Seek leadership endorsement for participation
    2. Identify a co-facilitator
    3. Conduct informal needs assessment to identify pre-implementation tasks
    4. Complete your facility application for inclusion in the next cohort and complete all required pre-work (e.g., read Facilitator's Manual in its entirety, complete TMS modules)
  • Implementation (~4 months)
    1. Join weekly implementation cohort calls (16 weeks total)
    2. Launch group
    3. Join PRIDE Community of Practice Calls (quarterly)
    4. Join PRIDE Open Office Hours (monthly)
    5. Document outcomes and report data for evaluation to PRIDE National Team as requested
  • Sustainment
    1. Continue participation in PRIDE Community of Practice
    2. Continue participation in PRIDE Open Office Hours
    3. Identify next start date for subsequent group cycle

Departments

  • LGBTQ+ Veteran care
  • Whole health

Core Resources

Resource type Resource description
PEOPLE
  • Group Facilitator (2 hours/week during consultation phase; 1 hour/week for sustainment)
  • Clinical Application Coordinator (2-5 Hours for clinic build)
PROCESSES
  • PRIDE Facilitation Manual (provided to all partner sites)

Optional Resources

Resource type Resource description
PEOPLE
  • LGBTQ+ Veteran Care Coordinator (internal consultant)
  • Intimate Partner Violence (IPV) Coordinator (internal consultant)
  • Infectious Disease provider (internal consultant)
  • Women Veterans Program Manager (internal consultant)
  • Whole Health Coordinator (internal consultant)
TOOLS
  • Telehealth Service Delivery

Support Resources

Resource type Resource description
PEOPLE
  • PRIDE National Team
PROCESSES
  • PRIDE Facilitation Manual
  • Ongoing consultation, problem solving, resource sharing, and implementation support
  • Welcome package with symbols of safety
TOOLS
  • Staff Training (optional)

Risks and mitigations

Risk Mitigation
LGBTQ+ Veteran risk for suicidal ideation Pre-Screen appointments to review risk factors, develop safety plan, and refer to appropriate supports
Increasing LGBTQ+ Veteran health literacy and visibility may increase pressure to improve access to care for this group (e.g., PrEP availability, Endocrinology) Consultation calls to assist sites in navigating these situations and developing a coordinated care model within their facility structure
Facility environment (lack of visibility, community resources, rurality, or provider biases) Consultation calls to problem solve local barriers

Contact

Comment

Comments and replies are disabled for retired innovations and non-VA users.

VA User (Social Worker, Outpatient Substance Abuse) Innovation adopter posted

I led a Pride In All Who Serve group at VA Hudson Valley and am currently leading my second cohort. This is a great opportunity for our LGBTQ+ veterans and the feedback from our veterans has been positive.

1
VA User (Social Worker, Outpatient Substance Abuse) Innovation adopter deleted

This comment has been deleted.

VA User (Nurse) posted

What a timely initiative! Much needed for our veterans!❤😊

3
VA User (PRRC Nurse/Recovery Coordinator) Innovation adopter posted

Good afternoon,

I would like to initiate and lead a "Pride in All Who Served," at our facility. I am at the VA of Western New York in Buffalo. I have read about the purpose of this group and find there is a great need for LGBTQ Veterans at our VA. I need to know how I can get official permission to get this education/support group launched.

I can devote two to three hours per week to lead this gathering, including the consultation session to get started. If anybody can point me in the right direction, please email me at timothy.ward5@va.gov.

3
VA User (LGBTQ+ Veteran Care Coordinator) Innovation adopter posted

The Salt Lake City VA has had great success in implementing "Pride in All Who Served" at our facility. We have received excellent feedback regarding the content of the group manual. The monthly calls are supportive and helpful with the program as well as implementing affirming healthcare overall. I highly recommend it!

3
VA User (LGBTQ+ Veteran Care Coordinator) Innovation adopter deleted

This comment has been deleted.

VA User (Local Recovery Coordinator) Innovation adopter posted

I am the LGBT VCC at a small, rural facility in WI. I was introduced to this project early on and was fortunate to collaborate as an early spread site. This group has been just what our site needed to meet the needs of rural LGBT Veterans who are struggling with limited resources in the community and limited knowledge of VA resources available. Feedback has been overwhelmingly positive in terms of finding meaning, validation of identity and sense of belonging and community. Additionally the evaluations and feedback has been invaluable in terms of Veterans engaging both VA and community partners in LGBT Veteran services. This project has also been a catalyst for increasing visibility and dialogue on the importance of meeting the needs of LGBT Veterans. It has also helped in creating buy-in with leadership in terms of prioritizing and highlighting healthcare disparities and addressing those needs head on.

4
VA User (Psychiatrist) Innovation adopter posted

I'm the LGBT VCC at a small rural outpatient clinic and residential rehabilitation center. I would love to bring this to us in VISN 20, Oregon.

3
VA User (LGBT Coordinator) posted

Hi there, I am new to the VA and work in Columbus, OH as the LGBT Care Coordinator. I would like to learn about the program and try to get it adopted in VISN10

3
VA User (Program Support Assistant) posted

I am not a direct care provider and I work for RCS/Vet Centers. I would like to learn about the program and try to get it adopted in VISN9/TVHS and in 10RCS/Vet Center Program.

2

Email

Email with questions about this innovation.

About

Origin story

Dr. Tiffany Lange wanted to fill a critical patient service gap for a vulnerable population. However, there were no evidence-based interventions for LGBTQ+ Veterans. Through an iterative process, the group content and process has been shaped by Veteran feedback, relevant literature, and VA initiatives (e.g., Whole Health). Group participants were active in i ... Dr. Tiffany Lange wanted to fill a critical patient service gap for a vulnerable population. However, there were no evidence-based interventions for LGBTQ+ Veterans. Through an iterative process, the group content and process has been shaped by Veteran feedback, relevant literature, and VA initiatives (e.g., Whole Health). Group participants were active in identifying meaningful topics for care, provided recommendations about design of handouts, and contributing to a list of community resources. The spread of this service is a source of pride and purpose for the “original group” members.

Original team

Tiffany Lange, PRIDE Program Developer (she/her)

Implementation & Training Lead (2016-2021)

Heather A. Sperry (she/her)

Director of Clinical Implementation (2021-present)

Michelle M. Hilgeman (she/her)

Director of Evaluation (2017-present)

Michelle Wilcox (she/her)

Deputy Director of Clinical Implementation (2021-present)

Robert J. Cramer (he/him)

Evaluation Team (2017-present)

Courtney Houghton (she/her)

Executive Assistant (2021-present)

Teddy Bishop (he/they)

Deputy Director of Evaluation (2019-present)

Blaine Fitzgerald (she/her)

PRIDE Diffusion Specialist (2020-2023)

Sierra Phillips (she/her)

Community Partnerships Program Manager (2021-present)

Anna Craycraft (she/her)

Education Program Manager (2021-present)

Shilpa Trivedi (she/her)

Evidence-Based Practice (EBP) Program Manager (2022-present)

Search tags

Access to Care Coordinated Care Diversity, Equity, and Inclusion Health Equity High Reliability LGBTQ+ Health Mental Health Outpatient Care Primary Care Rural Health