Abstract

This qualitative study explored BSW students’ understanding of LGBTQ populations based on a content analysis of student papers written for a required diversity course and to use the findings to identify learning gaps. Using the rigorous and accelerated data reduction (RADaR) method, 17 papers were qualitatively analyzed by extracting key categories and organizing them into thematic codes. The assignment guidelines included an analysis of historical influences and social issues relevant to understanding oppression and/or marginalization as well as identifying interventions at the micro, mezzo, and macro levels. Findings revealed evidence to support themes of Access to Rights, Oppression of Mental Health, Counseling and Support, Educational Programming, and Equality. Students recognized historical and social issues impacting this population, yet interventions strategies at the individual and macro levels of practice were very limited. When compared to competencies two and three of the Educational Policies and Accreditation Standards set by the Council on Social Work Education, the results underscore the need to improve student readiness to practice with this population. Specifically, to demonstrate engagement in anti- racist and anti-oppressive practices and increase application of self-reflection including identification of steps students can take to minimize bias and be more effective in practice. The processes the authors undertook to explore this topic could serve as an example for other educators in the use of a qualitative approach in evaluating and revising course content.

Keywords: LGBTQ+ issues, baccalaureate social work education, teaching methods, cultural competence

Introduction

The education and training of students to promote multicultural competence is of vital importance within the field of social work. Competencies 2 and 3 from the Council on Social Work Education [1] Educational Policies and Accreditation Standards clearly address the advancement of human rights and social, racial, economic, and environmental justice as well as “engaging in anti-racism, diversity, equity, and inclusion in practice” (p. 9). Historically, social work students and practitioners have reported low levels of readiness to work with LGBTQIA+ populations. For example, Craig et al. [2] surveyed BSW and MSW students regarding their self-assessed readiness to practice social work with LGBTQIA+ clients and found that LGBTQIA+ students reported low levels of readiness and even lower readiness for their non-LGBTQIA+ peers. This exists even while social work students often report a positive attitude toward the LGBTQIA+ population [3-5]. Additionally, program directors and faculty perceive their social work programs as competent in preparing students for direct practice with LGBTQIA+ clients [6].

Research on student knowledge and readiness to practice with LBGTQ clients has often focused on using survey methods for data collection among MSW students and programs. McCarty Caplan [6] found that social work students rated their programs’ competence lower than the faculty did, and that the faculty rated their programs lower in LGBTQIA+ competence than program directors did. Another study used online surveys and interviews of MSW students and alumni to assess readiness to practice with LGBTQIA+ populations who have substance use disorders. Dentato et al. [7] found that students and alumni did not feel adequately prepared to work with LGBTQIA+ clients affected by substance use and, in particular, transgender clients. Dessel and Rodenborg [8] examined the effects of a cultural competence course on MSW students related to their attitudes about military policy, marital equality, and LGBT discrimination. Students increased their understanding of discrimination yet attitudes remained the same as these were generally affirming from the start. Lastly, in a study by McCarty Caplan [6] found a significant relationship between institutional LGBT-competence and individual LGBT-competence among MSW programs.

Some studies included both BSW and MSW level students. Craig et al. [2] surveyed BSW and MSW students who identified as LGBTQIA+ from multiple universities regarding their perceptions of homophobia, and institutional non-discrimination policies as well as their preparedness to work with specific LGBTQIA+ groups. The participants were largely MSW students (76%) and the results were reported as an aggregate of both types of students. These LGBTQIA+ students reported lower levels of readiness to work with many subpopulations under the LGBTQIA+ umbrella, particularly with transgender populations [2]. Nowaskie et al. [9] studied the cultural competence of healthcare professional students with LGBTQIA+ patients. Surveying students from multiple schools that offered healthcare degrees, all levels were included from first- year students through graduate school. Results indicated moderate knowledge levels but low clinical preparedness, and found no significant differences among the disciplines, however, social work students reported the highest ratings on all scores [9].

These studies shed light on the need to better prepare students for practice with LGBTQIA+ populations, and perhaps even more so with specific subpopulations such as transgender clients; however, the preparedness of BSW students is not clearly demonstrated in the literature and shows a limited amount of qualitative exploration. This content analysis of ethnographic papers will explore students’ knowledge and understanding of key aspects of oppression and marginalization experienced by the LGBTQIA+ community.

Guidelines

Teaching diversity is not new in social work program curricula. CSWE Educational Policy and Accreditation Standards (EPAS) refer to culturally informed practices throughout the nine competencies. Competency 2 focuses on human rights and social justice for everyone. This competency addresses social work advocacy at all levels of practice (individual, family, group, organizational, community, and system levels) and other practices that promote social, racial, economic, and environmental justice [1]. While specific groups are not mentioned here, the emphasis is on human rights for all. Competency 3 clearly addresses the inclusion of gender identity and expression, sex, and sexual orientation as dimensions of diversity impacted by White supremacy and the use of privilege and power within systems of oppression [1]. Students are expected to demonstrate anti-racist and anti-oppressive practices at all levels of practice and “demonstrate cultural humility by applying critical reflection, self-awareness, and self-regulation to manage the influence of bias, power, privilege, and values in working with clients and constituencies…” [1].

A semester-long diversity course is a requirement for undergraduate social work students attending this southern United States institution. The course objectives include demonstrating knowledge related to demographics, unique lifestyles, customs, and value systems of various populations at risk, recognize and manage personal prejudices and values, demonstrate a commitment to advocacy and social action toward social and economic justice, and to develop beginning generalist social work skills with individuals and institutions representing diverse populations at risk using ecosystems perspectives.

Purpose

While the course covers a multitude of diverse populations, issues related to understanding and working with members of the LGBTQIA+ community is covered in the curriculum. Attitudes toward members of the LGBTQIA+ community and the training of students have improved in recent years; yet the assessment of students’ competence to work with sexual minority clients, particularly assessment of undergraduate social work students, is lacking. This content analysis attempts to make a contribution toward filling the gap and to provide recommendations for undergraduate education related to preparing students for effective and affirmative practice with members of the LGBTQIA+ community.

Methods

This content analysis included student papers from a diversity course that is required of all undergraduate social work students. The diversity course requires each student to write a final comprehensive paper that delves into a specific diverse group (of the students’ choosing), focusing on the American experience. Possible groups include African Americans, Asian/Pacific Islander Americans, Native American/Alaskan Natives, Hispanic/Latino-a Americans, Immigrants, Older Adults, Individuals with Developmental and/ or Physical Disabilities, Bi-Racial/Multi-Racial Americans, and LGBTQIA+ Persons. “Women” as a diverse group was not often chosen as students were encouraged to choose a group different from their own and most social work majors identify as female.

The paper guidelines included a cultural description of the diverse group the student chose (in this case, LBGTQIA+) such as characteristics and influential historical events, description of social issues faced by some members of this group and explain how oppression and marginalization influence the intersection of group identity and issues they face, identify at least one intervention for each level of practice (micro, mezzo, and macro), and lastly, discuss the importance of understanding this diverse group and summarize special cultural considerations to effectively implement the interventions they identified. Students were expected to integrate a minimum of eight peer-reviewed journal articles in addition to other sources. Papers needed to be a minimum of five pages (excluding cover page and references).

Participants

Student papers written between January 2021 and December 2022 were targeted for this study. Across four semesters, 92 papers were submitted. Of these papers, 19 students chose to focus on the LBGTQIA+ community; more than any other diverse group represented. As two papers did not address 50% or more of the assignment’s guidelines, 17 papers were used for the analysis. Gender of the students cannot be assumed from the papers that were analyzed.

Data Collection

After receiving formal approval from the Institutional Review Board (IRB), the research team moved forward with the next phase of the study, which involved accessing and identifying the student papers from the archived course classrooms. These papers, which were part of a broader dataset stored within an online learning management system, were carefully selected based on predefined inclusion criteria to ensure relevance to the study’s focus. The research team took extensive measures to guarantee the confidentiality and integrity of the data during this process, ensuring that all identifying information was securely removed to maintain anonymity and protect the privacy of the students involved. Once identified, the student papers were systematically downloaded and saved in a secure, cloud-based folder that complied with institutional data storage and security protocols. With the data securely stored and readily accessible, the researchers then initiated the data analysis phase of the study.

Data Analysis

Using the rigorous and accelerated data reduction (RADaR) technique [10], the authors employed a collaborative, team-based methodology to systematically code and analyze the content of the ethnographic papers. This process was designed to ensure a comprehensive and rigorous analysis through multiple phases. The initial step in the analysis involved reformatting the papers in a uniform and consistent manner, allowing for a standardized approach to the subsequent stages. This was crucial for maintaining consistency and reliability as the team moved into the second phase, which entailed the creation of structured data tables. These tables served as a foundation for organizing the content and facilitating a clearer understanding of the data.

In the third and fourth steps, a data reduction technique was applied. This technique helped to streamline the extensive data into manageable components by extracting key categories and organizing them into thematic codes. The reduction process was guided by specific parameters outlined in the assignment's guidelines, which included historical influences, social issues, and instances of oppression and/ or marginalization. These categories were instrumental in identifying overarching themes within the data that would later be analyzed for deeper insights.

Following the reduction of data into these predefined categories, the team then proceeded to the coding phase. During this stage, the data was systematically analyzed to identify and highlight themes that aligned with the concepts of cultural humility and cultural responsiveness. These themes included self-reflection, the identification of privilege, and the processes of learning and unlearning, among others. By focusing on these key aspects, the authors aimed to explore how cultural dynamics and awareness were represented and engaged with in the ethnographic papers, ultimately contributing to a richer understanding of the complexities of culture in diverse social contexts.

Results

Based on key components of the assignment guidelines, themes emerged related to knowledge of history, knowledge of social issues, and intervention skills. Knowledge of history reveals Access to Rights; that students are aware of certain laws, events, and societal expectations and pressures that have affected the LGBTQIA+ population. Heteronormative and gender role pressures provide a context in which to understand political mechanisms of oppression. One student recognized the significance of the “Don’t Ask, Don’t Tell” policy instituted by President Bill Clinton during his administration, and that although this policy was

removed under President Obama in 2011, this policy did not allow for service members to cite their significant other as their next of kin or beneficiary [at the time] which resulted in various financial and legal challenges for LGBTQIA+ services members and their families. (BSW Student)

BSW students acknowledged empowering events such as the Obergefell v. Hodges [11] Supreme Court decision that marriage between same sex partners cannot be denied, and understood that the right to marriage only occurred in more recent history. One student wrote,

It’s crazy to think that people discriminate against the LGBTQ community because in my generation it’s so normalized and accepted. Then you look at the facts and realize that the first state to allow same sex marriage was Massachusetts, and that happened in 2004. That was not that long ago at all! In recent years, there has been a wave of social justice warriors trying to make things “right.” People today are a lot less likely to turn a blind eye to social injustices towards others. (BSW student)

Well before the right to marry, students noted how equal access to employment was hindered.

In 1953, President Eisenhower banned gay people from federal jobs with an executive order that stayed in place for more than 20 years. This influenced the LGBTQ+ experience in America because this ruled out a large number of jobs that they were previously eligible to hold. (BSW student)

The theme Oppression of Mental Health demonstrates the students’ knowledge of social issues that connect to significant risks for depression, anxiety, and suicide. A variety of concerns primarily focused on “coming out” to others, discrimination in healthcare, mental health issues, the impact of homophobia, homelessness, and the intersectionality of belonging not only to the LGBTQIA+ community, but also to other group identities that may be marginalized as well. “Many people that are a part of this community face mental health issues. Depression, anxiety, and suicide are some issued faced in the LGBTQIA+ community” (BSW student). Citing the fact that LGBTQIA+ adolescents are at a much higher risk for suicide, the same student noted that this “shows that people in the LGBTQIA+ community are at risk for developing mental health issues leading to suicide.”

The issue of homophobia not only impacted legal decisions, but on a social level led to the marginalization of LGBTQIA+ individuals. One student connected to this personal form of discrimination.

Imagine going applying for a job that you are qualified for but denied the position because the manager is homophobic. As an African American woman, I understand the way this feels, because it is something that me and my people frequently experience. It is even worse when a member faces homophobia in their own home from their family. This can cause them to suffer from depression, and unfortunately suicide. (BSW student)

Intervention skills targeted micro, mezzo, and macro level efforts. As each of these levels of practice are vital to social work education, themes for each level were identified. Micro interventions revealed the theme Counseling and Support. Counseling, in general, was often mentioned.

As Social Workers our jobs are to help everyone and not judge people by the color of their sexuality. When a social worker is dealing with a client that have experienced sexual abuse or physical abuse in adolescent from their peers or family, we would want to get them into some counseling while also figuring out if they need to be pulled away from the family. If they are feeling suicidal should ask them if they have a plan or when they plan on doing so, we can help talk them out of the plan or tell them they can always call us if they feel like they will self-harm themselves. (BSW student)

Advocacy is also mentioned when working directly with LGBTQIA+ individuals.

For members of this community, past trauma is common due to the stressors associated with “coming out” or feelings of unacceptance. Along with the past, social workers must also respectfully serve these clients in their present obstacles and future endeavors due to advocacy. In regard to advocacy, social workers must provide their LGBTQ clients with resources or empowerment. (BSW student)

The theme Educational Programming describes the analysis of mezzo intervention skills. Some students focused on school-based efforts for LGBTQIA+ students, for example anti-bullying efforts in the school system.

A messo[sic] level intervention for LGBTQ dealing with mental health issues would be to prevent LGBTQ bullying in the school system. This can be achieved by schools widening lesson plans to address LGBTQ bullying and schools building relationships with local community organizations that work with LGBTQ individuals. (BSW student)

Another student recommended starting support groups at school.

The student is also interested in starting a general discussion support group meetings at his school. These general discussion groups could serve as a means of open dialogue, conversation, and catharsis for the entire student body, on a host of current and pressing issues facing us today. A sense of community and confidentiality can be achieved if all participants can agree to uphold these certain standards. (BSW student)

Other students recommended specific programs that provide a variety of mezzo interventions.

The True Colors United program would be considered this level of an intervention because their mission is to make solutions happen to be able to help homeless lgbtqia[sic] youth. They are a nonprofit organization with donations that are deductible. According to truecolorsunited.org, they specialize in advocacy, training, education, youth collaboration, and technical assistance programs. (BSW student)

The last theme is Equality. At the macro level, students largely identified current policies without offering a critique to recommend changes or development of policy that advocates for LGBTQIA+ individuals. In addition to the ruling that allowed for same-sex marriage, several students noted legislative needs to protect access to housing. The role of the Department of Housing and Urban Development in conjunction with the Fair Housing Act is noted by one student,

People who identify as LGBTQIA+ can face discrimination in the housing market, and this can often add to the issue of homelessness in the LGBTQIA+ community. The Fair Housing Act addresses housing discrimination based on sex discrimination including sexual orientation and gender. The Fair Housing Act prohibits, ‘housing and housing-related discrimination because of race, color, national origin, religion, sex (including gender identity and sexual orientation), familial status, and disability’ (The Department of Housing and Urban Development, 2022, pp.10). (BSW student)

Largely, however, students made general statements such as,

The need for advocating for the LGBTQ+ is in constant need. Those who are a part of the culture constantly experience discrimination and undergo hate crimes regardless of the rights that they attain. It is imperative to attain the fundamental knowledge that is required to further advocate and help those who are in need. Social workers must know the correct policy and guidelines when assisting someone who is a part of the LGBTQ+. From my own observation, I have gathered that there is a strong need for social workers to advocate. Social workers are frontline workers when making sure that the voices of the minority are heard. (BSW student)

Discussion

Students largely recognized the political and social issues and challenges facing the LGBTQIA+ community. First, significant historical events and attitudes that influenced the LGBTQIA+ community in terms of discrimination as well as anti-discrimination efforts were clearly identified as were the impacts of these events (and societal attitudes) on LGBTQIA+ individuals. Studies by Dessel and Rodenborg [8] and Nowaskie et al. [9] both reported positive results related to student knowledge or understanding of discrimination. This knowledge and understanding fits assignment and course learning objectives related to knowledge. Also, aspects of CSWE Competency 2 where students should recognize issues of advocacy related to human rights and social justice, and Competency 3 where students are recognizing systems of oppression.

Another key finding is that the interventions, particularly at the micro and macro levels, lacked critical thought. Micro level interventions tended to focus on generally recommending counseling, support groups, and links to resources rather than what the social worker can do to better work with this population. While the course is not focused on skill-building, discussions of key strategies are addressed in the readings and classroom activities. As noted above, Dessel and Rodenborg [8] and Nowaskie et al. [9] both reported positive results related to student knowledge or understanding of discrimination, yet Nowaskie et al. [9] noted low perceived clinical preparedness. This seems to fit with our finding that although key social issues such as depression, discriminatory healthcare, homelessness, and homophobia experienced by this population were identified, the link between these issues and needed skills or interventions was limited. Thus, CSWE competencies 2 and 3 related to practices that promote social justice and anti-oppressive practice at the individual level are not clearly demonstrated.

Suggestions for educational programs dominated the mezzo level interventions to promote understanding of the LGBTQIA+ community by targeting the broader community, students at a school, social workers, and families of LGBTQIA+ individuals. A recent study conducted in the United Kingdom found benefit in group discussions, where similar issues of oppression and marginalization are attributed to lack of knowledge or misunderstanding. The use of storytelling and humanizing the impact of cultural and historical events encouraged positive exchanges and discourse, leading to growth of empathy [12]. These intervention approaches seem to fit with CSWE Competencies 2 and 3 related to practices that promote social justice and anti-oppressive practice at the group and organization level.

At the macro level of practice, a limited number of policies were recognized as either beneficial to the LGBTQIA+ community, or even more rarely, that policies needed to be passed or updated. Based on our search of the literature, students’ understanding of policy, other than exploring the social work program or institutions' cultural competence, have not been specifically studied. It is possible that policy analysis is implied with measures of knowledge. Thus, the level of policy understanding and analysis does not fit CSWE Competencies 2 and 3 related to practices that promote social justice and anti- oppressive practice at the community and systems level. Course learning objectives that ask the student to demonstrate a commitment to advocacy and social action as well as beginning generalist social work skills with individual and institutions representing diverse populations (such as the LGBTQIA+ community) are not clearly or completely demonstrated through this assignment.

The last key finding is that cultural humility or self-awareness is not clearly apparent from the analysis. This critical self-reflection also involves affective processes where students are “tasked with understanding, questioning, and supporting (or rejecting) their existing beliefs, attitudes, values, and ideas…” [13]. The assignment guidelines did not include self-reflection; therefore, this finding is not surprising. However, as previously noted, previous studies have identified a lack of preparedness based on self- perceptions of the students. Even students who identify as LBGTQ reported lower levels of readiness to work with many specific LGBGTQ populations, particularly with transgender populations [2]. Thus, CSWE competencies and course learning objectives were not met. CSWE Competency 3 emphasizes critical reflection and self awareness. Additionally, the course learning objectives included recognizing and managing personal prejudices and values.

Recommendations

While these recommendations are based on the findings from this content analysis, the processes we undertook to explore the topic could serve as a guide for other educators. The first recommendation is to help students identify strategies to promote access to resources, ensure rights, and advocate for policy changes (CSWE Competency 2). For example, students in our social work program focus on rural populations. A rural article summary assignment was implemented to ask students to summarize an article related to a diverse group (such as LGBTQIA+) in relation to rural social work settings; and based on the identified mechanisms of oppression and marginalization, identify how social workers can improve conditions for the marginalized rural population.

Second, assist students to engage in anti-racist and anti-oppressive practices that clearly address the identified social issues (CSWE Competency 3). From the results, an increased focus on more specific implications for micro and macro level practice is warranted. An in class activity was added to explore specific social work interventions and approaches related to various diverse groups. Groups of students were given a different diverse group (such as LGBTQIA+) for whom the groups summarized some key dimensions and/or issues faced; and identify implications for social work practice at each level (micro, mezzo, and macro) for each dimension/issue based on the textbook reading.

Last, increased application of critical reflection to discuss their level of self-awareness, implicit biases, self-regulation (CSWE Competency 3) is suggested. Throughout the course, students are now encouraged to explore their own awareness and biases. For example, in a revised version of this ethnographic paper assignment, students define humility and answer the following question, “How might you apply self-awareness and self-regulation to manage the influences of personal biases and values in working with diverse clients and constituencies?” Additionally, a journal assignment, based on an assigned book chapter reading, asks students to reflect on their own biases related to diverse groups of people in American society. Students choose two (2) different biases they hold, explain each bias, and describe what steps they can take to minimize this bias to be effective in practice.

Limitations and Conclusion

There are several clear limitations of the study. First, it is a qualitative study of a limited number of student papers. Additionally, the authors took an interest in papers that were written specifically about the LGBTQIA+ population which was only one of many marginalized populations covered in the course. Thus, the expectations of what the students would be able to offer in one class assignment (although a final, comprehensive paper) are not likely fulfill the educational competencies. Lastly, the course does not teach or practice intervention skills with students. Types of interventions and special considerations at each level of care are discussed, however.

This content analysis examined 17 undergraduate social work student papers on the LGBTQIA+ community’s experience related to historical events, the impact of marginalization, and recommendations for social work practice. The study aimed to provide recommendations for undergraduate education related to preparing students for effective and affirmative practice with members of the LGBTQIA+ community. Recommendations, based on the results of the content analysis, were made. First, provide students more opportunities to identify specific actions or, as per the assigned textbook, “implications for practice” related to each diverse group discussed in the course to better prepare the student for the final assignment. Second, clearly ask students to explore their own biases and ways to remain aware and minimize the impact of bias, power, and privilege when working at each level of practice. Though not an exhaustive list of educational strategies, this content analysis provided a priceless opportunity to assess the diversity course from a rich, qualitative perspective.

Ethical Declarations

Competing interests:

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

As a content analysis of previously collected documents, informed consent could not be obtained from the individual participants included in the study.

The protocol was approved by the Institutional Review Board at the university affiliated with the first author in accordance with the ethical principles set forth in the Belmont Report and follows federal regulations based on the Federal Policy for the Protection of Human Subjects.

Additional Information

The data that support the findings of this study are not available openly. The data are, however, available from the authors upon reasonable request and with the permission of the primary author’s university Office of Sponsored Research and Programs.

References

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