By the NATA LGBTQ+ Advisory Committee
Editor’s note: Throughout June, NATA News is sharing content written by members of the NATA LGBTQ+ Advisory Committee related to different facets of LGBTQ+ health and patient care.
Imagine keeping a secret about yourself at work and at home. What if you didn’t know how people would react if you told this secret about yourself? You might be fearful to put yourself in a situation in which you may experience discrimination or harassment.
Many people experience and grapple with making the decision to come out as LGBTQ+ every day.
“Coming out” refers to a process in which people who are LGBTQ+ share their identity (e.g., sexual orientation or gender identity) with other people. “Closeted” or “in the closet” are adjectives for people who are LGBTQ+ and have not disclosed their sexual orientation or gender identity to others.
According to a recent study conducted by the Human Rights Campaign Foundation and the University of Connecticut2 analyzing responses from more than 17,000 young people, participants in youth sports continue to fear discrimination from their coaches and teammates, leading to a majority of them choosing to remain in the closet about their sexual orientation or gender identity.
The results indicated that 80 percent of LGBT teenagers and 83 percent of transgender teenagers are not out to their coaches. Furthermore, 41 percent of transgender boys, 34 percent of transgender girls, 31 percent of nonbinary youth and 11 percent of all LGBTQ+ youth don’t feel safe in the locker room.
Another study conducted by the Gay, Lesbian and Straight Education Network3 found more than a quarter of LGBTQ+ student athletes reported being harassed or assaulted while playing school sports because of their sexual orientation or gender expression.
These surveys suggest the athletic environment is often hostile toward LGBTQ+ people.
Robbie Rogers, the first openly gay major professional athlete in the U.S., echoed these concerns when he said, “I cared more about how my teammates were going to treat me, how my coach was going to react. That's the biggest thing. Guys are afraid of being treated differently by their teammates."1
A study conducted by the NCAA revealed that twice the number of LGBTQ+ student athletes report experiencing hostility in their environment compared to their straight counterparts.4 Specifically, their sexual identity (39 percent) was the source of harassment, whereas that was almost nonexistent among their heterosexual counterparts (1 percent).
Harassment can often originate from the coaches, as more than half of LGBTQ+ student athletes reported being deliberately ignored or excluded compared to their heterosexual counterparts, or being a target of derogatory remarks via electronic means twice as frequently. They were also four times more likely to feel pressured to be silent about their identity by the coaches.
If athletes perceive athletics as a hostile environment and choose not to come out to their peers and coaches, can one assume that athletic trainers feel the same way? Are athletic trainers choosing not to be out because of the athletic environment where they work? Are athletic training students choosing not to be out because of fear of discrimination and harassment from those in their athletic setting?
Discrimination in Health Care
Although discriminatory behaviors toward athletic trainers has not been exhaustively studied, a new article by Crossway et al. (2019) examined NCAA collegiate student athletes’ perceptions of LGBTQ+ athletic trainers.5 It concluded that “in general, the NCAA student athletes had positive perceptions of ATs who identified as LGBTQ.” Specifically, it showed that student athletes perceived it was appropriate for LGBTQ+ ATs to provide care regardless of the sex of the athletes to who they provide care. Student athletes also indicated they would seek health care from and felt comfortable approaching ATs who identified as LGBTQ+.
In contrast, other studies examining health care providers indicate that there is a possibility of hostile attitudes. Among LGBTQ+ physicians, 10 percent reported they were denied referrals from their heterosexual colleagues, 15 percent were harassed by a colleague and 22 percent had been socially ostracized. Furthermore, 65 percent had heard derogatory comments about LGBTQ+ individuals, 34 percent observed discriminatory care of an LGBTQ+ patient, 36 percent observed disrespect toward LGBTQ+ patients’ partners and 27 percent observed discriminatory treatment of a LGBTQ+ colleague.6
Similarly, among nurses, nearly 30 percent of LGBTQ+ nurses stated their workplace was LGBTQ+ unfriendly. For the more than 70 percent who initially reported the workplace was LGBTQ+ friendly, their open-ended responses indicated that while the environment was not necessarily hostile, it was not necessarily inclusive. In addition, although 78 percent were out to all of their friends, only 57 percent were out to all of their coworkers. Some nurses mentioned that many coworkers, supervisors and patients exhibited discriminatory behaviors or verbal harassment toward LGBTQ+ workers.7
Creating an Inclusive Environment for LGBTQ+ Health Care Providers
What can we do to better create an inclusive environment for all?
To create an inclusive environment for all, it is important that everyone in athletics, including ATs, proactively address LGBTQ+ harassment. This will send a message to all members involved that inclusion of LGBTQ+ people is important. Remaining silent sends the opposite message, and validates the name calling, taunting and/or discriminatory behavior.8
The NCAA Office of Inclusion offers five ways to create an LGBTQ+ inclusive athletics department.9
- Have a written nondiscrimination policy that explicitly includes “sexual orientation,” “gender identity” and “gender expression.”
- Have an LGBTQ+-inclusive code of conduct for players, coaches, athletic administrators, staff and fans.
- Ensure media communications include nondiscrimination clauses and use of LGBTQ+-inclusive language.
- Have athletic departments maintain up-to-date LGBTQ+ inclusion resources readily available for coaches, players and staff throughout the year.
- Have mandatory LGBTQ+-inclusion trainings sessions for staff and students to review policies and codes of conduct.
Workplaces for athletic trainers should incorporate these best practices. A work setting missing one of the five points should strive to have them incorporated into the policies. This will ensure an environment that is inclusive to all individuals.
Discrimination vs. Harassment in the Workplace
The work environment may not always be friendly to LGBTQ+ athletic trainers. LGBTQ+ athletic trainers should understand the options they have when facing workplace discrimination or harassment because of their sexual orientation or gender identity. Important concepts to know to protect you and your colleagues include:
- The definition of discrimination and harassment based on sexual orientation and gender identity in the scope of the workplace
- How federal and state law applies to discrimination and harassment
- Title IX protections
- The role of the Equal Employment Opportunity Commission (EEOC).
It is important to understand what qualifies as discrimination or harassment based on sexual orientation or gender identity. Title VII of the Civil Rights Act of 1964 prohibits employment discrimination by an employer or supervisor that includes any aspect of employment. Harassment does not have to be of a sexual nature and can include offensive remarks about a person's sex, sexual orientation or gender identity.
Although the law does not prohibit “teasing,” off-hand comments or isolated incident harassment becomes illegal when it creates a hostile or offensive work environment or when it results in an adverse employment decision, such as the AT being fired or demoted. In the case of harassment, the harasser can be the AT’s supervisor or coworker, a supervisor from another area or a patient.10
The 2015 Obergefell v. Hodges decision by the U.S. Supreme Court was a milestone in guaranteeing same-sex couples the right to legally marry.11 On June 15, Bostock v. Clayton County, Georgia, the U.S. Supreme Court also made a historic decision to protect LGBTQ+ employees from discrimination on the basis of sexual orientation and gender identity, similar to race, color, sex, religion, national origin, age or disability.12 The EEOC interprets and enforces Title VII of the Civil Rights Act of 1964, which includes a clause prohibiting sex discrimination as also forbidding any employment discrimination based on gender identity or sexual orientation.13
Each state has prerogative over addressing harassment or discrimination in the workplace within its jurisdiction. Currently, 21 states and the District of Columbia have statutory protection for all workers from discrimination based on sexual orientation and gender identity. One state has statutory protection for all workers based on sexual orientation only. Six states prohibit discrimination for all public employees based on sexual orientation and gender identity and five states prohibit the same based on only sexual orientation.14 For a current report on state laws regarding discrimination of LGBTQ+ people, see the Human Rights Commission’s website.
Title IX of the Education Amendments of 1972
The U.S. Department of Education’s Office of Civil Rights enforces Title IX protections regarding sex discrimination for all educational entities that accept federal funds from the Department of Education. Title IX protections state, “No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance.”
Some key areas in which recipients have Title IX obligations include recruitment, admissions, counseling, financial assistance, athletics, sex-based harassment, treatment of pregnant and parenting students, discipline, single-sex education and employment. Title IX obligation includes public school districts, post-secondary institutions, charter schools, for-profit schools, libraries and museums. Individual institutions are given guidance in complying with Title IX, and most public and private colleges and universities fund a Title IX office to maintain compliance.15
NATA Code of Ethics16
The NATA Code of Ethics (COE) was updated in 2015 to reflect the movement toward a more inclusive and diverse workplace. By adding sexual orientation and gender identity, the NATA COE provides inclusion and protection for not only patients within the LGBTQ+ community, but its members as well. The strength of an ethical document reflecting the value of diversity within NATA provides protection for members with regards to harassment and discrimination.
The following statement in the NATA COE is relevant to the discussion of ethics and treatment of athletes/patients in the AT setting. The NATA LGBTQ+ Advisory Committee believe this extends to the AT as well.
- Members shall practice with compassion, respecting the rights, well-being and dignity of others.
- Members shall render quality patient care regardless of the patient’s race, religion, age, sex, ethnic or national origin, disability, health status, socioeconomic status, sexual orientation, or gender identity.
BOC Standards of Professional Practice17
The Board of Certification Inc. Standards of Professional Practice, which establish duties and obligations in which those holding the ATC credentials have to uphold, also reflect the need for inclusiveness in patient care. Every athletic trainer is mandated to comply with the Practice Standards at all times.
The following statement is in the BOC Standards of Professional Practice and is relevant to the treatment of all athletes and patients within our setting regarding patient care responsibilities
- The athletic trainer or applicant: Render quality patient care regardless of the patient’s age, gender, race, religion, disability, sexual orientation, or any other characteristic protected by law
Furthermore, the BOC non-discrimination statement18 was also updated in May 2019 to now read, “The [BOC] does not discriminate against any individual on the basis of race, color, religion, age, sex (including pregnancy, childbirth and related medical conditions), ethnic or national origin, disability, health status (including HIV/AIDS status and sickle cell or hemoglobin C trait), socioeconomic status, marital status, sexual orientation, gender identity or expression, military or veteran status, genetic information, or any other characteristic protected under applicable federal, state or local law.”
As athletic trainers, we should create an inclusive environment so the patients who we treat feel safe and respected when under our care. However, it is also important for athletic trainers to work in an inclusive environment so we feel safe and respected when working. For this, it is important to know our legal rights so we can take appropriate steps to make our work environment as inclusive as possible. By following best practices and actively engaging in policy-making, we can create inclusive environments in which everyone feels that they can be themselves all of the time.
- Human Rights Campaign. Play to Win: Improving the lives of LGBTQ youth in sports 2018. https://assets2.hrc.org/files/assets/resources/PlayToWin-FINAL.pdf?_ga=2.260704717.158300568.1530301759-1588415886.1530301759
- GLSEN .The Experiences of LGBT Students in School Athletics (Research Brief) 2013. https://www.glsen.org/sites/default/files/The%20Experiences%20of%20LGBT%20Students%20in%20Athletics.pdf
- Rankin S, Merson D. Campus Pride 2012 LGBTQ National College Athlete Report 2012. Charlotte, NC: Campus Pride. See Campus Pride Report Score Card, Appendix 5.
- Crossway A, Rogers SM, Nye EA, Games KE, Eberman LE. Lesbian, gay, bisexual, transgender, and queer athletic trainers; Collegiate student-athletes’ perceptions. 2018; 54: 324-333.
- Eliason MJ, Dibble SL, Robertson PA. Lesbian, gay, bisexual, transgender, and queer/questioning nurses’ experiences in the workplace J of Homosexuality 2011; 58: 1355-1371.
- Eliason MJ, Dejoseph J., Dibble S, Deevey S, Chinn P. Lesbian, gay, bisexual, transgender, and queer/questioning nurses’ experiences in the workplace. J of Professional Nursing 2011; 27: 237-244.
- NCAA. Champion of Respect. https://www.naspa.org/images/uploads/main/Champions_of_Respect.pdf
- NCAA. Five ways to have an LGBTQ-inclusive athletics department. http://www.ncaa.org/about/resources/inclusion/five-ways-have-lgbtq-inclusive-athletics-department#TBP
- U.S. Equal Employment Opportunity Commission. Sex Based Discrimination. https://www.eeoc.gov/laws/types/sex.cfm
- Workplace Fairness. Sexual Orientation Discrimination. https://www.workplacefairness.org/sexual-orientation-discrimination
- Bostock v. Clayton County, Georgia (Supreme Court of the United States). https://www.supremecourt.gov/opinions/19pdf/17-1618_hfci.pdf
- U.S. Equal Employment Opportunity Commission. What you should know about EEOC and the enforcement protections for LGBT workers. https://www.eeoc.gov/eeoc/newsroom/wysk/enforcement_protections_lgbt_workers.cfm
- Human Rights Campaign. State Maps of Laws and Policies. https://www.hrc.org/state-maps/employment
- U.S. Department of Education. Title IX and Sex Discrimination. https://www2.ed.gov/about/offices/list/ocr/docs/tix_dis.html
- NATA. Code of Ethics. https://www.nata.org/membership/about-membership/member-resources/code-of-ethics
- BOC. BOC Standards of Professional Practice. https://bocatc.org/system/document_versions/versions/171/original/boc-standards-of-professional-practice-2019-20181207.pdf?1544218543
- BOC. Board of Certification. http://www.bocatc.org/