(Research Hub Theater) Implementation and Outcome of Psychosocial Screening of Disability, Gender, and Sexual Identity in the Pediatric Spinal Dysfunction Population

Background and/or Objectives: To improve inclusivity in medicine, optimize quality of care, and support physician/patient rapport, physicians have been increasingly motivated to ask for patients’ preferences regarding gender identity, sexuality, and pronouns. Unfortunately, many adolescents with disabilities are excluded from these vital conversations, and disability identity (person first vs disability first language preference) is rarely addressed. In this Quality Improvement project, we aim to determine if patients of Spinal Dysfunction Clinic have ever been asked about their identity (disability/sexuality/gender/pronouns) at healthcare visits and determine if this can be a standard part of patient intake.

Design: cross-sectional study

Setting: Spinal Dysfunction Clinic (SDC) January 2022-November 2022 within a tertiary care pediatric hospital system.

Participants: All SDC patients ages 11-21 (n=47)

Interventions: Beginning in July 2022, disability, gender, and sexual identity questionnaires were distributed to participants at their appointment.

Main Outcome Measures: Percentage of patients completing the questionnaire, and descriptive statistics analyzing the summative questions at the end of the survey: (1) Have you ever been asked about your pronouns/gender/sexual identity at a healthcare appointment, (2) Have you ever been asked about your disability identity at a healthcare appointment.

Results: Prior to July 2022, 0% (n=0) of the 30 participants had their pronouns/disability/gender/sexual identity documented in their EMR at the time of their appointment. From July 2022-November 2022, 17 patients were seen, 35% (n=6) of whom completed the questionnaires; 100% (n=6) indicated they had never been asked about personal pronouns/disability/gender/sexual identity.

Conclusions: Although it is standard to ask adolescents about their pronouns/gender/sexuality at healthcare visits, adolescent patients in SDC were not being asked these important identity questions. Additionally, these adolescents had never been asked about their disability identity. Though the percentage of completed questionnaires was lower than desired, this project demonstrates it is possible to implement these questions as standard practice.