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LGBTQ: Community, Partner Abuse, and Dental Traumatology

Ryen Wilson & Dr. Eva Bender

Push your

Leading Edge

INTRO

Today's Agenda

LGBTQ CENTERED:

1. Communities

2. Partner Abuse

Today's Agenda

3. Dental Considersations

4. Questions/Discussion

5. References

Group Agreements

Group Agreements

  • Take care of yourself
  • Take space, make space
  • Call folks in, not out
  • Push your leading edge
  • Check our biases
  • Use "I" statements
  • Respect the opinions of others
  • There's no such thing as a wrong question
  • It's okay to be silent/quiet and listen 
  • What's said here stays here,

what's learned here leaves here

  • Please hold questions until the end
  • Start on time, end on time 

DV in LGBTQ

Communities

According to the National Coalition Against Domestic Violence (2018)

Stat

Snapshot

  • 43.8% of lesbian women and 61.1% of bisexual women have experienced rape, physical violence, and/or stalking by an intimate partner at some point in their lifetime, as opposed to 35% of cisgender heterosexual women.

  • 26% of gay men and 37.3% of bisexual men have experienced rape, physical violence, and/or stalking by an intimate partner in their lifetime, in comparison to 29% of cisgender heterosexual men.

  • Transgender victims are more likely to experience intimate partner violence in public, compared to folks who aren't trans.
  • Median lifetime prevalence of physical IPV was 37.5%, lifetime sexual IPV was 25.0%, past-year physical IPV was 16.7%, and past-year sexual IPV was 10.8% among transgender individuals. Compared with cisgender individuals, transgender individuals were 1.7 times more likely to experience any IPV. 2.2 times more likely to experience physical IPV. and 2.5 times more likely to experience sexual IPV.
  • Taken directly from the American Journal of

Public Health (2020)

DV in LGBTQ

Communities

According to the National Coalition Against Domestiv Violence (2018)

Stat

Snapshot

  • Bisexual victims are more likely to experience sexual violence, compared to people who are not bisexual. 

  • Black LGBTQ survivors are more likely to experience physical violence, compared to non-Black individuals.

  • White LGBTQ survivors are more likely to experience sexual violence, compared to non-white individuals.

LGBTQ Communities 101

LGBTQ

Communities

Sexuality

Sexuality composed of three parts:

1) Behavior- what you do

2) Orientation - who you want, who you love

3) Identity -

what you call yourself

Sexuality

When we make assumptions about sexuality, we miss opportunities for cultural humilty and trauma-informed care.

Sex vs Gender

Sex: Biological characteristics humans have based on internal/external sex organs, chromosomes, hormones, etc.

ex) Male, Female, Intersex

Intersex is a general term used for a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn’t seem to fit the typical definitions of female or male.

Gender: A society construct where a person is placed into the category of "boy" or "girl" based on sex assigned at birth.

ex) ciswoman, transman, butch, femme, androgynous

Sex?

Gender?

When we make assumptions about gender, we miss opportunities for cultural humilty and trama-informed care.

The Gender Unicorn

Gender-Inclusive Language

According to Efua Andoh from the American Psychology Association, gender-inclusive language "is about embracing communication that acknowledges the power differentials and dynamics of our society and their deleterious effects. It is about showing appreciation for the diversity everyone brings to the table. And finally, it is about creating cultures where people can feel free to be their full authentic selves."

Inclusive

Language

Unsure of someone's gender identity?

  • Use singular "they" until you can ask and clarify

Gender-Neutral Terms to Practice:

  • Patient
  • Partner
  • Person
  • Parent
  • Spouse
  • Survivor

When we use gender inclusive language, we create opportunities for trauma-informed care.

Pronouns

Pronouns are words that describe an individual without using their actual name

Why are pronouns important?

  • Important part of gender identity and gender validation
  • When we use the correct pronoun for people, it helps affirm who they are.
  • The opposite effect can happen when we misuse an individuals pronouns. This is true for both cis- and trans- individuals.

Pronouns

Homo-, Bi-, Trans-

Phobia & Heterosexism

Homophobia/Biphobia/Transphobia:

  • The irrational fear, strong disliking/hatred, and/or belief in negative stereotypes about gay, lesbian, bisexual, and transgender individuals

Homo-,

Bi-,

Trans-

phobia & Heterosexism

Heterosexism:

  • The assumption and/or belief that heterosexuality and hetersexual relationships/dynamics are the presumed and only acceptable "norm" in society

Invisibility & Attack

Invisibility & Attack*: The 4 I's of Oppression

*Concept articulated by UC Davis Professor Gregory M Herek. Heterosexism, just like the three phobias, operate both through invisibility and attack. Queerness (sexuality) in and of itself is invisible. You can look at someone and speculate, but sexuality itself is invisible; when queer folks act in non-heterosexual ways publicly (i.e. hand-holding, kissing), they are at the precipice of attack by society. Why? Because of homophobia, biphobia, transphobia, and heterosexism.

Homo-, Bi-, Trans- phobia and heterosexism all operate under the 4 I's of oppresson:

Interpersonal

  • Invisibility: Heterosexism; Not educating oneself on LGBTQ communities
  • Attack: Discrimination and violence towards LGBTQ people

Ideological

  • Invisibility: Societal belief that being straight is the norm/There are only two genders
  • Attack: Belief that LGBTQ people are mentally ill and abnormal

Internalized

  • Invisibility: Low self-esteem, self-doubt, believing one is less than because they are in the LGBTQ community
  • Attack: Self-harm, drug addiction, eating disorder, suicide

Institutional

  • Invisibility: Lack of visibilty of LGBTQ people in media or lack of mention in schools, history, etc
  • Attack: The Defense of Marriage Act (1996) - effective for 27 years.

(Repealed in 2022 by the Respect of Marriage Act)

Partner Abuse vs

Domestic Violence / IPV

LGBTQ Partner Abuse

What is PA?

LGBTQ Partner Abuse

  • "A systematic pattern of behaviors in which one person non-consensually uses power to try to control the thoughts, beliefs, actions, body, and/or spirit of their partner." *

*Referring to a person in an intimate relationship of some sort.

-TN;LR, Boston MA

Zooming in

LGBTQ Partner Abuse: ZOOMED IN

  • "A systematic pattern of behaviors in which one person non-consensually uses power to try to control the thoughts, beliefs, actons, body, and/or spirit of their partner*."

*Refering to a person in an intimate relationship of some sort.

-TN;LR, Boston MA

  • Systematic Pattern: Abuse happens over time. Isolated incidents occur, and they are not abuse. Important to look for patters of control.
  • Non-consensual: There are dynamics between adult individuals where there are power and control dynamics after consent has been given; abuse is non-consensual.
  • Power and Control: Involves "power over". Not inherently about physical size but about a partner using their power to control the other person(s).

Myths

Myths about LGBTQ Partner Abuse

  • "Abuse just happens in cisgender heterosexual relationships"
  • "Abusers tend to be the bigger, stronger, more masculine partner in the relationship"
  • "They're mutually abusive"
  • "Women abusers are less physically abusive than men abusers"

LGBTQ

vs

CisHet

PA

How LGBTQ and Cisgender Heterosexual partner abuse differ

Rates of abuse may be similar, but lgbtq IPV can show up in ways different from cishet IPV.

  • Lack of LGBTQ visibility, leading to lack of visibly healthy LGBTQ relationships
  • Internalized homo/bi/transphobia can lead to self-blame
  • Less overall resources for LGBTQ Abuse survivors
  • Survivor and Abuser may share mutual support systems

Forms &

Tactics of Abuse

Forms of Abuse:

Emotional, Financial, Sexual, Cultural/Identity, Physical

  • Prohibiting partner from gender-affirming healthcare
  • Name-Calling specific to partners identity
  • Prohibiting cultural holiday celebrations
  • Dictating clothing preferences
  • Degradation based on identity: "You're not ____ enough"
  • Institutional System Threats: ICE, Police, etc
  • Perpetuating Identity Stereotypes

Cultural/Identity:

  • Outing/Preventing partner from coming out
  • Dead-naming
  • Intentional misuse of pronouns
  • Control of resources: community support, immigration status resources,
  • Not allowing partner to use assisted device
  • Now allowing partner to speak chosen language

Tactics of Abuse: Lots of overlap

Emotional (mental/verbal):

  • Threatning suicide
  • Name-Calling
  • Gaslighting/Crazy-Making
  • Apologizing/Constant Promises of change
  • Filibuster Fighting
  • Shaming
  • Electronic Monitoring
  • Cheating
  • Causing hypervigilance/fear
  • Isolation

Physical:

  • Starving/Controlling of food
  • knowingly exposing partner to STI
  • Sleep deprivation
  • Forcing drug use
  • Forced physical isolation
  • Blocking means of transportation
  • Exposing partner to known allergy
  • Physical Violence

Sexual:

  • All non-consensual sex
  • Stealthing
  • Withholding sex as a manipulation tool
  • Ignoring safe words
  • Fetishizing/Exotifying
  • Unsolicited sexting
  • Filming without partners knowledge
  • Forcing sex with others/Trafficking
  • Withholding sexual health status information
  • Prohibiting birth control
  • Prohibiting abortions

Financial/Economic:

  • Stealing wages
  • Identity theft
  • Controlling spending
  • Forcing survivor to support abuser
  • Ruining credit
  • Forcing/controlling use of disability/welfare benefits of survivor
  • Controlling whose name is on property (lease, mortgage, etc)
  • Making survivor financially dependent on abuser

Dental Traumatology

Why is this important as Dentists?

Screening+ Signs of Abuse

Screening & Clinical Signs of Abuse

Signs of Abuse specific to the Head and Neck Region:

  • Injuries to teeth, soft tissue, jaw, face, head, or neck
  • Soft and hard palate bruises or abrasions from penetration may indicate forced sexual acts.
  • Abscessed or lost nonvital teeth caused by violent physical impact to an area of the face or from traumatic tooth fractures.
  • Torn frenum due to trauma
  • Fractured teeth, nose, mandible, maxilla, and signs of healing fractures on radiographs
  • Signs of strangulation
  • Bite marks
  • Hair loss
  • Difficulty eating
  • Dental Neglect
  • Fear of dental care

Screening:

  • Inform patient that every patient is screened for DV so they don't feel othered/singled out
  • Look for signs of overall abuse (Anxiety, Overbearing-partner, drug/pain med dependence, fear of partner, eating disorder signs)
  • Then check for clinical signs during Rooming, EO, IO exam
  • Refer/Report if required by law

*A sign of abuse does not necessarily prove abuse.

*We as dental providers may be the first person to be in a position to offer support to a survivor. Learning how to screen for abuse creates opportunities for trauma-informed care.

Behavioral + Clinical Signs cont.

Behavioral and Clinical Signs of Abuse cont.

*A sign of abuse does not necessarily prove abuse.

*We as dental providers may be the first person to be in a position to offer support to a survivor. Learning how to screen for abuse creates opportunities for trauma-informed care.

Mandated Reporting

Protocol for Mandated Reporting

Dental Practitioners are Mandated Reports and must follow the same protocol as other healthcare professionals if abuse is screened.

Adapted from “Report of Injuries by a Firearm or Assaultive or Abusive Conduct” developed by the Bay

Area Legal Aid, California Alliance Against Domestic Violence, Family Violence Prevention Fund, San

Francisco Domestic Violence Consortium, and California Medical Association and reporting procedures

Bay Area Legal Aid for the Family Violence Prevention Fund

Galop's 2022

Study

Galop's 2022 Study

LGBT+ anti-abuse charity. We work with and for LGBT+ victims and survivors of abuse and violence.

Galop's 2022

Study

Galop's

Study

Takeaways

Takeaways from the Study

Why is this important?

Having a good understanding of the relationship between some LGBTQ communities and the police is important in determining whether your decisions will help survivors or inadvertently cause more harm. Something to think about.

Dental

Triggers

Dental Triggers to Consider

*Practice ongoing consent throughout appointment while working with a PA survivor*

General Dental Triggers

  • Pain during injections
  • Pain during drilling/scaling
  • Feeling like you can’t breathe/water in mouth
  • Cost
  • Judgment for having oral problems/not brushing
  • Judgment from family
  • History of negative experiences
  • Invasiveness
  • Sensory input (vibration, light, sound)

Triggers to consider when treating a survivor:

  • Touching the face or neck (ask for consent beforehand)
  • Being lectured to/providers seeming angry or upset
  • Having work done on visible teeth
  • Sudden noises or sensations
  • Bibs or thyroid shield on the neck
  • Having another face in close proximity
  • Being reclined in chair (vulnerable position)
  • Mouth being held open
  • Feeling out of control
  • Diminutive terms (honey, baby, etc.)

How we should treat

How to Treat Surivors - Trauma-Informed Care

Being Mindful of the Signs and having clear, open communication makes our patients feel safest.

Things to consider when treating a survivor:

  • Letting them know of sounds they might hear during the procedure
  • Having completely blacked-out eye wear in office
  • Having noise cancellation headphones in office
  • Any procedure with lots of heme (EXT, SRP, etc), let them know so they can prepare to keep their eyes closed if seeing blood is triggering
  • Have multiple bib attachment options (the alligator bib clip (chain) could be a trigger)
  • Having a lightweight lead apron (less restricting and heavy)
  • Ask patient if they would like updates during procedure/visit (gives back sense of control that may've been taken from them)
  • Periodically check in with your patient and ask if they're doing okay in your chair
  • Offering nitrous oxide (survivor may decline because it may feel too restrictive)

Our Project &

Findings

Our Project & Findings

Poster

Takeaways

  • Majority of UCSF Dental students/faculty have a good clinical foundation in treating patients, positive attitudes around LGBT communities, and a basic knowledge in LGBT nomenclature

  • Most participants expressed a need for more edu around treating survivors (both LGBT and CisHet)

  • There is a ton of room for further research around LGBT Dental care and PA/DV education

  • LGBT patients would benefit from us receiving more edu around treating LGBT community members

Future Applications of Research

  • Same project from the survivors perspective
  • Surveying all dental schools with modified LGBT-DOCSS
  • Implementing more PA/DV/IPV training in dental school education

Takeaways, Questions,

References

Important Takeaways

Acknowledgement

Unlearning

Relearning

Putting into Practice

Success

Additional Resources from RAINN (Rape, Abuse, & Incest National Network, rainn.org)

Questions?

References:

Levin L, Bhatti C. The role of dental

professionals in identifying, reporting, and supporting

domestic violence victims. Dental Traumatology.

2024;40(Suppl. 2):3–9. https://doi.org/10.1111/edt.12897

https://ncadv.org/blog/posts/domestic-violence-and-the-lgbtq-community

https://mandatedreporter.com/blog/vital-statistics-on-domestic-violence-in-lgbtq-communities/

https://bjs.ojp.gov/library/publications/violent-victimization-sexual-orientation-and-gender-identity-2017-2020

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8998579/ (Dentists’ Competence and Knowledge on Domestic Violence and How to Improve It—A Review)

https://www.ihs.gov/doh/portal/feature/DomesticViolenceFeature_files/EnhancingDentalProfessionalsResponsetoDV.pdf

https://avp.org/wp-content/uploads/2019/01/NCAVP-HV-IPV-2017-report.pdf

https://www.apa.org/ed/precollege/psn/2022/09/inclusive-language

https://researchinvolvement.biomedcentral.com/articles/10.1186/s40900-023-00463-0#:~:text=The%20phrase%20%E2%80%9Cmen%20who%20have,communities%20%5B8%2C%2011%5D.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449332/

https://isna.org/faq/what_is_intersex/

https://lgbpsychology.org/html/sexual_prejudice_pre.pdf

https://www.nih.gov/nih-style-guide/inclusive-gender-neutral-language

https://lgbpsychology.org/html/prej_defn.html

Trans Student Educational Resources, 2015. “The Gender Unicorn.” http://www.transstudent.org/gender.

https://www.aclu.org/news/lgbtq-rights/what-you-need-to-know-about-the-respect-for-marriage-act

https://www.law.cornell.edu/wex/defense_of_marriage_act_(doma)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4309219/ (Improving Clinical Practice: What Dentists Need to Know about the Association between Dental Fear and a History of Sexual Violence Victimisation)

https://decisionsindentistry.com/article/recognize-the-signs-of-domestic-violence/

https://www.ihs.gov/doh/portal/feature/DomesticViolenceFeature_files/CoverStory_June08.pdf

tnlr, open minds open doors, transforming domestic vioelce programs to include lgbtq survivors, technical assistance manual, Boston, MA, 2011

tnlr, power with power for, creating a survivor-centered organization, training manual, Boston, MA, 2016

https://dentallearning.org/course/DomesticViolence/Domestic%20Violence.pdf

https://news.arizona.edu/story/dentists-can-be-first-line-defense-against-domestic-violence

https://onlinelibrary.wiley.com/doi/10.1002/j.0022-0337.2009.73.4.tb04720.x

References:

https://www.futureswithoutviolence.org/userfiles/file/HealthCare/mandatory_calif.pdf

https://www.searchandselect.com/insights/careers-guidance/PES

https://bellevuedentaloasis.com/blog/how-to-help-with-dental-anxiety/

https://www.dentalcity.com/product/9519/palmero-cling-shield-protectall-x-ray-leaded-aprons?55-551BL&gad_source=1&gclid=Cj0KCQiAyKurBhD5ARIsALamXaEicjyBdZl1sYH3_f9H6ugeJtrQ_IeP1IhvNMz2xDq_0dzThqkoydIaAuzLEALw_wcB

https://www.chronicle.com/article/beyond-critical-thinking/

https://www.kavo.com/en-us/handpieces-small-equipment

https://www.eventreg.purdue.edu/info/central-service/pdf/cis/CIS276.pdf

https://www.procarefamilydental.com.au/fear-of-the-dentist/

https://www.thehotline.org/resources/domestic-abuse-transgender-non-binary-survivors/

https://ajph.aphapublications.org/doi/10.2105/AJPH.2020.305774

https://www.american.edu/spa/news/same-sex-violence.cfm

https://www.rainn.org/news/barriers-reporting-sexual-violence-lgbtq-communities

Butterby, K., Donovan, C. The Impact of Police ‘Process-Driven Responses’ on Supporting Lesbian, Gay, Bisexual and/or Transgender + Victim-Survivors of Domestic Abuse in England. J Fam Viol (2023). https://doi.org/10.1007/s10896-023-00608-5

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