Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec;90(12):1030-1037.
doi: 10.1111/josh.12964.

Applying a Structural-Competency Framework to the Implementation of Strategies to Reduce Disparities for Sexual and Gender Minority Youth

Daniel G Shattuck  1 , Cathleen E Willging  1 , Amy E Green  2
Affiliations

Applying a Structural-Competency Framework to the Implementation of Strategies to Reduce Disparities for Sexual and Gender Minority Youth

Daniel G Shattuck et al. J Sch Health. 2020 Dec.

Abstract

Background: Sexual and gender minority youth (SGMY) are at high risk for adverse health outcomes. Safer schools decrease this risk. The US Centers for Disease Control and Prevention has identified 6 practices that can make schools safer for SGMY, yet few US schools implement them all. We apply a structural competency framework to elucidate factors contributing to this implementation gap.

Methods: We conducted 75 interviews and 32 focus groups with school professionals in 18 New Mexico high schools to assess factors impacting implementation of the practices over 2 years. We analyzed data using iterative coding, thematic identification techniques, and the sensitizing concept of structural competency.

Results: Themes included: rendering an invisible population visible; critical thinking about LGBTQ inequalities; building school personnel capacity; intersecting cultural, religious, and political conflicts; and tackling community-based sources of stigma and discrimination.

Conclusions: Underlying cultural and structural forces render SGMY invisible and constrain what schools can accomplish. Professional development encouraging critical thinking about structural inequities is foundational, but efforts to close the implementation gap must attend to structural forces producing disparities for SGMY. Structural competency can strengthen the ability of the Whole School, Whole Community, and Whole Child model's cross-sector coordination of policy and process to meet the needs of every student.

Keywords: LGBTQ youth; WSCC model; health disparities; implementation science; sexual and gender minority; structural competency.

PubMed Disclaimer

Conflict of interest statement

All authors of this article declare they have no conflicts of interest.

References

    1. Johns MM, Poteat VP, Horn SS, Kosciw J. Strengthening our schools to promote resilience and health among LGBTQ youth: emerging evidence and research priorities from The State of LGBTQ Youth Health and Wellbeing Symposium. LGBT Health. 2019;6(4):146‐155. - PMC - PubMed
    1. Kann L, McManus T, Harris WA, et al. Youth risk behavior surveillance—United States, 2017. MMWR Surveill Summ. 2018;67(8):1‐114. - PMC - PubMed
    1. Hatzenbuehler ML, Pachankis JE. Stigma and minority stress as social determinants of health among lesbian, gay, bisexual, and transgender youth: research evidence and clinical implications. Pediatr Clin North Am. 2016;63(6):985‐997. - PubMed
    1. US Centers for Disease Control and Prevention . School Health Profiles 2018: Characteristics of Health Programs Among Secondary Schools. 2019. Available at: https://www.cdc.gov/healthyyouth/data/profiles/. Accessed August 24, 2020.
    1. Eisenberg ME, Resnick MD. Suicidality among gay, lesbian and bisexual youth: the role of protective factors. J Adolesc Health. 2006;39(5):662‐668. - PubMed

Publication types