Inclusive
Inclusivity enables all people to participate in and benefit from services; the goal is for all services to reflect a patient’s circumstances appropriately without bias.
Efforts to create inclusion should specifically consider the needs of LGBTQI+ people, who often experience discrimination and mistreatment in the health care setting, contributing to disparities in SRH outcomes.32 Inclusiveness involves standardizing and normalizing sexual orientation and gender identity (SOGI) conversations.33, 34, 35
To establish an inclusive clinical environment, it is essential to address both administrative processes, such as registration and documentation, as well as patient care practices. This includes ensuring that patient information in medical records and portals accurately reflects their identity.
Rather than making assumptions, healthcare providers should ask patients about their sex assigned at birth, current anatomy, preferred name, gender identity, and pronouns. These details should be carefully documented in the medical record to ensure respectful and personalized care throughout the patient’s journey, including follow-up. The CDC offers suggested language for these questions, and for electronic health record (EHR) documentation.36 These questions should be asked routinely of all patients to normalize and standardize interactions and enable people to describe themselves accurately without being targeted.37, 38
Inclusive care is also culturally and linguistically affirming, meaning that services respond to diverse cultural health beliefs and practices, preferred language, health literacy, and other communication needs of patients. The National Culturally and Linguistically Appropriate Services (CLAS) standards should be applied. The National Coalition for Sexual Health offers resources on how to create a more inclusive clinic environment, including self-assessment tools.39
Workforce composition is an essential element of inclusion. Patients benefit when providers and staff in clinical settings are representative of communities being served and made up of individuals of diverse background and identities in terms of age, race, ethnicity, gender identity, disability status, sexual orientation, and other characteristics. The CLAS standards mentioned above include recommendations for recruiting a diverse clinical workforce.40 People seeking SRH care value providers’ clinical expertise, skill sets, and characteristics—such as empathy and nonjudgmental attitudes—regardless of health professional type, and collaborative interdisciplinary care teams can best deliver quality care.40
Specific considerations for providing care inclusive of adolescents are described in Exhibit 4.
Exhibit 4. Providing Care Inclusive of Adolescents
Confidential SRH services should be made available to adolescents while observing state laws and any legal obligations for reporting.
- Ensure adolescents know their rights. Adolescents feel safer accessing care and more comfortable sharing personal information during appointments when they know their rights related to confidentiality, including how billing and insurance notifications are handled.
- Know your state laws and clinic policies. Statutes on rights of minors to consent to health care vary by state. Be familiar with clinic policies around billing for minors and possible limitations of confidentiality related to insurance.
- Address young people’s needs, desires, and concerns. Routinely address needs and preferences for SRH care and individual goals, including those related to pregnancy prevention, enabling healthy pregnancy, and disease prevention, regardless of a person’s age or sexual activity. Address relationships, sexual behaviors, and needs for the full range of SRH services.
- Provide youth-friendly services. Peer educators and support groups can improve clinical outcomes and patient satisfaction with care. The involvement of a trusted adult, with permission, can also improve similar outcomes.
- Integrate SRH care into other settings, including schools, to increase access and improve educational opportunities for adolescents.
- Access specialized training. Trainings specific to adolescent care may include contraceptive provision, including IUD placement, appropriate referrals, and familiarity with confidentiality laws and policies.
Source: These key steps were adapted from ACOG’s Committee Opinion Number 710, Counseling Adolescents About Contraception,41 and the American Academy of Pediatrics Policy Statement, April 2024.42