Teaching young children about the existence and acceptance of LGBTQ people [PODCAST]

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“Even though there has been a lot of progress, LGBTQ youth are still struggling with discrimination. I am disheartened that 40 percent of LGBTQ youth surveyed by the Trevor project in 2020 seriously considered suicide in the previous 12 months, and the amount of LGBTQ youth reaching out to the Trevor project crisis centers has doubled at times during the COVID 19 pandemic.

I have pediatric patients in my clinic tell me that they are nervous to reveal their sexual identities to family and friends. Many of my young LGBTQ patients have mental health issues. According to a recent Human Rights Campaign survey, only 26 percent of LGBTQ teens say they always feel safe in their school classrooms. Only five percent of LGBTQ teens say all of their teachers and school staff support LGBTQ people. Additionally, sixty-seven percent of LGBTQ teens report that they have heard family members make negative comments about LGBTQ people. Many LGBTQ youths are still homeless. It is clear that there is much more work that needs to be done.”

Alexis Smith is a family physician.

She shares her story and discusses her KevinMD article, “The importance of teaching young children about the existence and acceptance of LGBTQ people.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Alexis Smith. She is a family physician, and she wrote the KevinMD article “The importance of teaching young children about the existence and acceptance of LGBTQ people.” Alexis, welcome to the show.

Alexis Smith: Thank you so much for having me, Kevin. I really appreciate it.

Kevin Pho: So we’ll get into the article in a little bit, but first off, can you share your story and journey to where you are today?

Alexis Smith: Yeah. So I grew up in Tucson, Arizona, in the 1990s and early 2000s, and I discovered I was an LGBTQ individual when I was a high school student. But the environment was not welcoming to LGBTQ students, so I remained closeted for about six years of my life. I watched other people get bullied. I did not get bullied myself, but by watching other people who were out, who were identifying as LGBTQ, get bullied, I personally felt marginalized, and I felt isolated. There were many other students like me, but we were not talking to each other, so we felt like we were all alone, and we had decreased senses of self-worth. Also, at school and at home, I wasn’t hearing much about LGBTQ people being talked about, and what I did hear was usually negative. And so as an adult, I had to kind of rebuild my self-esteem, because the environment that I grew up in was not very supportive of LGBTQ individuals.

I’ve always been passionate about health care, so I became a public speaker about LGBTQ issues when I did come out, because I felt like it was part of my social responsibility. But in health care, I think it’s also important to mention the health disparities within this population. We have the privilege as physicians of being able to help influence society, as well as influence how health care is being done and how health care is being changed as time goes on. And I feel it is very important to share my story, that it’s not good for LGBTQ youth to not be talked about, to not be acknowledged, and to not be accepted.

And so even though we have marriage equality today, LGBTQ students still get bullied, and LGBTQ students still suffer from mental health disparities. In a Trevor Project survey, 68 percent noted that they felt generalized anxiety disorder symptoms, about 40 percent of students were seriously considering suicide, and over half of trans and nonbinary youth were seriously considering suicide, in the 2020 Trevor Project survey. These statistics are not OK. For me, this is a public health crisis, in my opinion, and I think as health care providers, we really need to do our part to address this and help as much as we can.

Kevin Pho: So can you tell me how your story has influenced your career so far as a physician in your practice?

Alexis Smith: Yeah. In my practice, I do well-child pediatric visits, and there are templates that talk about sexual education and gender identity, but they don’t tell us what to say. But I make sure to tell parents that it’s very important to normalize these topics from an early age, because we want to teach children either to be allies to LGBT students, or, if they do identify as LGBTQ, that it’s OK. So I try to normalize this early in my well-child visits. So that’s partially how it has affected my career.

Also, as a medical student, when we were still advocating for marriage equality, I sent a video to Upworthy, which got circulated and got, I think, 41,000 views. So I learned the power of my voice as a medical student, too, through that experience. And I’m just inspired to keep talking when I see these health care disparities out there, when I see my patients come up to me and say, “I’m nervous to tell my family and friends about my sexual orientation or gender identity,” and when I see young children talk to me and wonder about their insurance and if it will cover their transgender care. These are reasons that I want to continue to speak up, especially being a part of that community, and especially knowing how it feels to feel a little taboo and othered at a young age. It’s one of the reasons I talk now.

Kevin Pho: Now, during your medical training, can you share some of the challenges that you may have gone through as an LGBTQ individual?

Alexis Smith: During my medical training, I think that actually, because I’m fairly cisgendered, and because you do rotations and you’re not very well known by the people you rotate with, I actually usually just did not talk about my sexual orientation while I was going through rotations, because I just wanted to be evaluated based on my performance alone. So I don’t think it was that challenging to go through rotations being myself, just because it was so easy to not share that part of my identity. My classmates were actually very accepting of me, so it wasn’t that challenging for me as a medical student. I would say the parts of my life that were much more challenging were being a high school student and being an early college student.

Kevin Pho: And one of the things that you had mentioned before was that you had to rebuild your self-esteem. What did you mean by that?

Alexis Smith: People had said to me many times, when they did not know that I was identifying as an LGBTQ individual, what they really thought of LGBTQ people, and a lot of these statements were negative, such as, “LGBTQ people are not attractive, they’re not smart, they’re not cool, they’re not moral.” These are the kinds of things that I had to really look in the mirror and sit with myself and think about: who I am, and if this part of me really changed everything else about me. These people were confiding in me what they think about LGBTQ people. They don’t think that about me; they’re not saying that about me, but not knowing that part of my identity. And I thought, “Well, does this part of my identity really change who I am otherwise?” And I had to learn that the answer is no, and that it’s just another part of my identity.

Just as with a straight person or an LGBTQ person, there are many things that go into identity which make us either moral or immoral, or whether we’re attractive or unattractive. I don’t even like saying that, but I think what makes an attractive person is a person who treats everyone with respect, a person who works hard. I think those are the qualities that make someone an attractive person, and I think that’s regardless of sexual orientation or gender identity.

Kevin Pho: So let’s transition now into the KevinMD article that you wrote. It was written back in March, and it’s titled “The importance of teaching young children about the existence and acceptance of LGBTQ people.” Now, for those who didn’t get a chance to read that article, can you just walk my audience through it and share the story of why you decided to write it?

Alexis Smith: Yeah. So during the pandemic, I was actually thinking back to my youth a little bit, because we all had time to sit and reflect. And then I was reading statistics about the mental health disparities of LGBTQ people, and I came across a TED Talk by a British gentleman named Tim Ramsey. He actually has an organization that helps teach young children about the existence and acceptance of LGBTQ people in developmentally appropriate manners, and I really want to highlight “developmentally appropriate manners.” We’re not talking about teaching young children about sex. What we’re talking about is saying that there may be two moms in a family, there may be a Disney prince who really wants a prince instead of a princess as their partner, or maybe there’s a Disney prince who really identifies deep down as a princess and changes their gender. That’s what we’re talking about. We’re just talking about acknowledging that people exist and accepting them.

And he said that not having that part acknowledged growing up, not having LGBTQ people acknowledged, it felt taboo and inferior to him, and I felt the same way. Mr. Ramsey is doing great work, and I wanted to help expand the work that he’s doing into the medical field. I think as physicians, again, we have a responsibility to really push for the mental health and well-being of LGBTQ youth, and that includes teaching young children not to bully. So whether it means we need to teach all children about the existence and acceptance of LGBTQ people so that, if they’re LGBTQ, they can grow up feeling proud of who they are, or, if they’re straight, they can grow up being an ally to this population and standing up to bullies, we need to do that, and that’s a public health issue.

In my article, I did not mention specific things that I think clinicians can do, but I believe that the well-child visit is a great opportunity. So, having those templates that say to talk about sexual orientation and gender identity, we really need to sit down and normalize that with the parents and try to teach them in a culturally appropriate manner, within the developmental range that the child can imagine at that age, being very appropriate for developmental age. We can also put inclusive posters and literature in the waiting rooms. And really respecting pronouns is very important, because suicide rates for transgender people are much lower when we respect pronouns.

Kevin Pho: Could you go into a little more detail for those pediatricians and other family physicians who may be listening to this podcast? In the exam room, what are some ways that we can approach these issues with our young patients?

Alexis Smith: So in the exam room, I have a check box that is correlated to the Bright Futures templates, and they’re for well-child visits, for ages 0 through 18. At about age 3, they mention talking about gender identity, but all it says is “gender identity.” So I think at that age, it’s important to say that this is the age when a child may gravitate more toward one gender or another gender, and it’s important to teach the child that either is OK, for themselves and for their friends, for example. When they become four, then they start having a box that says “sexual education,” four to 11. That’s all it says, “sexual education.” I think it’s important to say that it’s important to teach the child that all gender identities exist, and that a little boy may like little boys, or they might like little girls. It’s OK either way. Their friends may be one way or another way. It’s all OK; accept it all.

Kevin Pho: Now, are there any specific LGBTQ issues that family physicians and pediatricians should be aware of?

Alexis Smith: I think right now, in 2021, the Human Rights Campaign has actually said there is the most anti-LGBTQ legislation out there in many years. They’re actually fighting against 252 different state anti-LGBTQ bills, and a lot of them are targeting the participation of transgender children in sports and using bathrooms of the gender that they identify with. This is very, very targeting and harmful to this population. The Human Rights Campaign, or, you know, the Trevor Project survey had actually mentioned that in 2020, before all these bills came out, transgender and nonbinary children were already contemplating suicide at a rate of over 50 percent. So with these bills, with this legislation targeting them, I think it’s very important to be especially attuned to their mental health and to their well-being, and to make sure that they feel accepted in society.

Another thing that’s really important right now, during the pandemic, is that there are a lot of children living at home, living in multigenerational families, who are not having the same access to a safe space as they used to have prior to the pandemic. So with the pandemic, along with the social isolation that a lot of our young kids are going through, LGBTQ youth may not feel like they’re able to be themselves at home. So that’s something to just be attuned to. I think it’s important to bring these children into the clinic, and it’s hard to do phone visits, because sometimes you don’t really have the child alone at the phone visit, and they might not tell you everything.

Kevin Pho: Now, you mentioned earlier that a lot of clinicians don’t have the appropriate training when it comes to issues specific to LGBTQ individuals. What are some resources that you could recommend in case clinicians want to research and look up more?

Alexis Smith: So I think that the American Association of Pediatrics has some good guidelines, but also CHLA, I think, is excellent in terms of talking to all children about the normalization of LGBTQ people in developmentally appropriate manners. They actually have an article about that, but they also have one about how to support LGBTQ youth as well, and I think that they’re excellent to go to. UCSF also has great websites for clinicians, training them on culturally competent care.

Kevin Pho: We’re talking to Alexis Smith. She is a family physician, and she wrote the KevinMD article “The importance of teaching young children about the existence and acceptance of LGBTQ people.” Alexis, you included a video as part of your article, and you mentioned in the past that you had videos on Upworthy that had a lot of traction. Can you speak to the platform that social media offers physicians to spread their message?

Alexis Smith: Yeah, I think that physicians are often very, very busy. We have a lot of charting, with a lot of electronic medical records that we have to get through, and we have a lot to say, but often it’s hard to find the time to get your voice out there. So with social media, I have a YouTube channel because I started it when I made an It Gets Better video, when the It Gets Better Project originally started. So that’s why I had to make the channel. That’s why it’s called Life Is Fun and Smiles: because I was trying to convince kids not to kill themselves. And I do want to say to any kids watching this video: It does get better. So really be yourselves. Stick with life. It really does get better, especially once you get out of your high school environment. I’ll say that right now.

But yeah, this platform, having a YouTube channel, allows you to say something once and then let your voice get repeated multiple times. I’m not famous, and I don’t have any connections, but if you have something that you want to say and an organization is willing to share your voice, I think that it’s important to speak up and speak from your experience. Physicians are so diverse, and we have so many different opinions and experiences and voices to put out there, so I’d really encourage all physicians to share their stories in whatever way possible. But yeah, that YouTube channel isn’t really trafficked much. When the videos get sent to the It Gets Better Project, or they get sent to Upworthy or to KevinMD, that’s when they tend to get watched.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Alexis Smith: My take-home message is that I want clinicians to know that marriage equality does not fix everything, and that we still need to really be there for LGBTQ people. Also, it’s great that the American Medical Association, the psychiatric association, and the pediatric association are so against these anti-trans bills, and I’m glad they’re putting statements out there. But in addition to that, we as a medical profession need to talk about normalizing LGBTQ people, the existence and acceptance, and teaching children in developmentally appropriate manners. I’m not talking about sex; I’m talking about Disney princes and princesses, thinking about it in a way so that LGBTQ youth are not going through this public health crisis of so much anxiety and so much suicidal contemplation. We need to make the change, and we physicians have social responsibility and the privilege of the ability to help. So I want to send that message home.

Kevin Pho: Alexis, thank you so much for sharing your time and insight, and thanks again for being on the show.

Alexis Smith: Thank you so much for having me, Kevin. I really appreciate it.

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