New RCSLT guidance to help you support LGBTQIA+ colleagues in the workplace

How can you support LGBTQIA+ colleagues in the workplace? In this podcast we speak with two of the authors of new guidance that deals with just that question.

We cover:
-  An introduction to the guidance, and supporting tools. 
- Why it matters.
- Why it is everyone's business, even if you do not identify as LGBTQIA+.
- How to use it as individuals or in teams.
- Understanding intersectionality.

Interviewees:
Kate Boot, Clinical Locality Lead (Cornwall, Devon, Somerset and Hampshire), Highly Specialist Speech & Language Therapist and Sensory Integration Practitioner 

Jessica Davies, Highly Specialist Speech and Language Therapist- Acute Medicine Team Lead, St Helier Hospital ,Epsom and St Helier University Hospitals NHS Trust

Resources:
Guidance on supporting LGBTQIA+ colleagues in the workplace: a guide for all: https://www.rcslt.org/learning/diversity-inclusion-and-anti-racism/supporting-lgbtqia-colleagues-in-the-workplace-a-guide-for-all/ 

The interview was produced by Jacques Strauss, freelance digital producer.

Transcript

Transcript Date:  

4 March 2024  

Speaker Key (delete/anonymise if not required):  

HOST: JACQUES STRAUSS  

KATE: KATE BOOT 

JESS: JESSICA DAVIES 

 MUSIC PLAYS: 0:00:00-0:00:06  

HOST: 0:00:07 Welcome to another RCSLT podcast. My name is Jacques Strauss.  

In today’s podcast we are talking to the UK SLT Pride Network, who, together with RCSLT, have produced guidance on working with LGBTQIA+ colleagues.  

Now, the question of DE&I initiatives – that’s diversity, equity and inclusion – is becoming increasingly politicised and controversial, which is why I think having open and frank conversations about the topic is so important.  

On the one hand, we know that whether it’s in a criminal justice setting, an educational setting, or indeed a clinical setting, we can improve outcomes with a more diverse workforce. But equally, we need to recognise that some DE&I efforts are not only ineffective, but sometimes even counterproductive.  

Given the crisis the NHS is in, it’s not surprising if there is pushback against DE&I, not only from certain politicians and parts of the public, but also from the workforce itself, and I think this is often the case because it’s perceived as a peripheral social justice issue.  

In this podcast we try to go a little deeper and explore why this is not only about the welfare of our colleagues, but how this can really impact people accessing speech and language therapy and their families.  

A link to this guidance is available in the show notes, and I would encourage you to read it.  

I started by asking our guests to introduce themselves.  

KATE: 0:01:37 I’m Kate [inaudible 0:01:38]. I am a speech and language therapist working in both independent practice and as a locality [inaudible 0:01:44], and I’m co-chair of the UK SLT Pride Network, and have been part of the committee in the network since it started nearly three years ago.  

JESS: 0:01:54 Hi, I am Jess [inaudible 0:01:55], I’m a highly specialist speech and language therapist working with adults in acute medicine and critical care, based in a hospital in South London. I’m also co-chair of the UK SLT Pride Network and have been working alongside Kate in developing this working group and guidance since it started. 

HOST: 0:02:15 Could you tell us a little bit more about what the guidance is, and why it’s important? 

KATE: 0:02:23 We have been working on a variety of guidance documents and resources. This originated from conversations with RCSLT and some of the other working groups a couple of years ago now. We’ve gone on a journey to understand what would be helpful and is important and needed for our profession in terms of supporting people’s development, and creating more LGBTQ+ affirming spaces for colleagues and student speech language therapists.  

And so, we have produced various guidance documents and resources. That includes a self and team audit tool, an LGBTQ+ affirming zones  of practice model, and a guidance document for the profession, all of which aim to help raise awareness and promote understanding of the context of working life for LGBTQ+ people, and what individual teams, services, and organisations can do to make their settings more inclusive, safer, more welcoming, and non-discriminatory for LGBTQIA+ SLTs, support workers, and students. 

JESS: 0:03:38 We’ve obviously had a lot of time to think about this guidance and how we support speech and language therapists and speech and language therapy students while we’re working on this. And as part of all that reflection as well, we are aware that we don’t represent everyone that we are trying to support. So, that’s really important for us to highlight as well. We can’t speak for all the experiences. Kate and I are cisgendered women, we’re white, we aren’t disabled, so we have reached out to other people to get their input as well to represent people of different races, different ethnicities, different religions, different abilities, and different lived experiences. So be that transgender SLTs and other people that we can’t imagine their experiences.  

KATE: 0:04:24 One of the resources that we’ve produced is the LGBTQIA+ affirming zones of practice. That is a piece of work that was born out of an idea, inspired to develop a model following our own reflective practice and our own CPD which has included work around anti-racism and questioning unconscious bias and optimising neurodiversity affirming practice that, Jess and I, we first encountered Andrew Ibraham’s becoming an anti-racism model. Some of that was through the RCSLT anti-racism workshop a couple of years ago. Also in my practice, work a lot with Kerry Murphy’s neurodiversity affirming zones of practice model.  

And so, inspired by those, we reflected on not having something like that for LGBTQ+ issues and topics. As therapists who are racialised white and we’re both cisgender, neither of us are physically disabled like Jess said earlier, those models have been instrumental in supporting our work to begin dismantling internalised racism, and thinking about ableism and understanding the unlearning and relearning that’s necessary for us to begin showing up differently, and leaning meaningfully into our own privileges as white people, cisgendered people, etc.  

And so, it felt like a good move to think about developing a tool like that for LGBTQ+ topics, which would allow us to lean into the intersectionality themes. Because, again, there are members of our profession, students that are in training, who have various protected characteristics, different intersecting experiences, and for whom potentially challenging certain experiences in a workplace or on a placement isn’t necessarily going to be as easy for them for various reasons. And so, this tool acts as a resource that individuals, teams, service leads, etc., can use to look at what zone they feel they’re in, where they see their learning needs sitting for themselves individually or a team. And it can be used quite informally as a bit of an audit resource, really, but help to shape maybe CPD plans and thinking about where a service needs to move in terms of creating more of those safe spaces and equitable and inclusive spaces for people.  

That’s one of the resources that’s launched that is hopefully going to be really helpful to people. And then we’ve also been working on an audit tool, so a self and theme audit. Thinking about people having a resource that they can look to that enables them to move forward with some of the work that’s required to create meaningful change for LGBTQ+ members of the profession that doesn’t mean leaning into those people in the profession too heavily. So, the audit tool is quite helpful because it’s signposting people to reflect on key aspects related to resources and materials, general policies and publications, thinking about induction processes, thinking about language and terminology, and microaggressions, for example, and giving people that signposting so they can go away and look to further their learning, sit with what shows up for them, but without having to necessarily lean into the LGBTQ+ openly out members of their team, for example.  

So, it’s not work that’s being pushed by those people. These are tools that we are hoping provide the non-LGBTQ+ people in our profession particularly with resources they can lean into that helps with that self-directed CPD, and conversation, so it eases off some of the pressure and the leaning into for a marginalised community of people.  

JESS: 0:08:28 It helps me imagine the ideal workplace where, if you’re starting in a new job and you walk in and someone has already thought of these things for you and you don’t have to be the one raising red flags or saying, oh, could we improve this just because you’ve noticed it from your own lived experience. The thought that someone else has already considered that for you and they’re working on it is really refreshing. And the sense of relief that would probably be there, I think, would be really, really welcomed.  

Just to pick up on that one example from the audit tool is kind of  

looking at the materials we use and the resources we use, and are we reviewing them to see how representative they are of our populations?  

For example, the cookie theft picture is a really well known picture in speech and language therapy. That got an update – or a glow-up, if you like – where it’s the dad inside who’s doing the domestic chores, and the mum is out mowing the lawn, which was wonderful from a gender perspective. But again, are we looking at our resources to see if ability is represented, if people from different races are represented, are the families all heteronormative or do they have maybe two mums, two dads?  

These are questions that may not arise to everyone, so the audit tool and the guidance piece all together is there to help foster these discussions and facilitate this growth and learning in a department, so it’s not all the emotional labour on those staff members.  

HOST: 0:10:09 So, it’s not just about colleagues, it’s about people accessing speech and language therapy and their families as well. 

JESS: 0:10:15 It’s been interesting having these discussions as we’ve developed the guidance, because of course we work with people that fit into these communities as well, but that would be a massive piece of work to tackle everything all at once. So, I think we decided, first, we’ll focus on our workforce and the wellbeing of our workforce and the future generation, so the students coming up through universities and apprenticeships now. But also, that will have a knock-on impact, as you said, it will affect our client populations as well.  

But all of that is… to kind of go back to this whole thing that we are all human. We need to bring our whole selves to work. We don’t come in and we suddenly are a cookie cutter speech and language therapist one day. We come in with these individual things of our identity, and we shouldn’t have to leave them at home because they enrich our lives and our services. I’ve only ever found it has helped my interactions with my patients when I have been more human with them and not so robotic.  

It’s ideally to impact students and working speech therapists at the moment, but if it can have an impact for our service users, fantastic. 

HOST: 0:11:36 Can you give us a practical example of something that you would do with the guidance?  

JESS: 0:11:40 We’ve actually had one team very kindly review [Designs of Practice/designs of practice] for us already, which has already been published, and I’m sure we’re going to have some others have a look at the guidance as well.  

They took it and literally cut up all the different elements and statements that we had in there, and did it as a team building activity to see if initially whether they themselves could put the statements in the right zones of practice. I think that was a good example of how, as a team, they first worked out their understanding of the zones, before diving in completely fresh and trying to see where they were amongst all of that. That’s one example of how, as a team, they’ve collectively looked at things.  

We’ve also got support and guidance that goes with it, which has examples of perhaps statements or beliefs or thoughts. If the statements themselves in the zones of practice are a bit ambiguous for some or need a bit more explanation, you can go to the supporting document and have a look there, and perhaps that brings it to life a bit more for some people.  

KATE: 0:12:52 One of the things that came to mind is something that I’ve done previously with my teams and I’m going to be doing it again soon, is… we work predominantly with children and young people, and with part of our speech and language therapy work with them, we often use something called a word bluff, which is inviting a child to rate their knowledge of a word or a concept. I used these previously with my team for various different reasons related to safeguarding acronyms, anti-racism concepts. And I think you could use them similarly thinking about LGBTQ+ themes, and just inviting people to reflect and consider how they would rate their knowledge, and doing that in a way where you know your team, if you’re going to do with a team, you know which is the best way to go about doing that exercise. And so, it might look different with a new team. It might be much more of an anonymous activity, that there hasn’t got to be any outright ownership or talking through of anything.  

But for a previous team where I’ve worked alongside them for many years and we have much more psychological safety, it might be a much more open conversation, people being able to say, actually, I don’t really know what it means to be pansexual. Does anyone know what that means? Whereas you might have less of that conversation to begin with. I think you need to know your team.  

But that’s certainly been an activity that we’ve used in quite an informal way that’s just opened up some avenues for conversation or for people to reflect on where they might want to take it next, whether that’s through their clinical supervision or their CPD planning, or linking in with any of the EDI networks within an organisation, for example.  

HOST: 0:14:41 Fantastic. Thank you. That’s really helpful advice.  

I was having a conversation with a fairly experienced clinician in the NHS. To be clear, I think this person would describe themselves as liberal, as progressive. They work in a large tertiary hospital in central London. And their attitude was I just can’t with this EDI stuff anymore. We are sinking and this is all just guff, stop it. How would you respond to that?  

KATE: 0:15:09 I guess with those kinds of conversations, and I have had a few myself in the last six months, I think my response is, in part, influenced by who the person is that I’m hearing say that.  

If you take anti-racism work or LGBTQ+ issues, if a person who’s offering that feedback or that statement is not LGBTQ+ or is a white person, then I think navigating how you call people in and have conversations that may not be comfortable but allow you to hold people accountable. In relation to anti racism work, which Jess and I are navigating that journey and we know there’s no endpoint to that. But I certainly know I have more confidence now to handle a situation like that better than I might have done six months ago in terms of using my white privilege to hold people accountable and find a way of calling them in, not necessarily always calling people out, depending on the situation, the relationship, the safety you have as a member of marginalised groups.  

But finding a way to use your privilege meaningfully, because actually, if we don’t support the dismantling of those kinds of narratives and rhetorics (sic) around marginalised groups, many of whom have… people have protected characteristics that intersect between communities. There are many queer global majority and/or disabled people. But if we’re not having conversations that challenge and help to dismantle those narratives, things won’t change. Because it can’t be down to the members of those groups who do the dismantling.  

I think part of the conversation before in terms of how people use resources we can produce and any of the working groups produce, I think there’s also something to be mindful of knowing, especially if it’s with a team, knowing your team, knowing who’s in the team. Say, for example, you have one queer person in your team, is it psychologically safe with the rest of that team dynamic to approach certain topics in a team setting? Knowing those relationships and team dynamics so you can do what you can to try and provide psychological safety, which is very personal. 

JESS: 0:17:34 I agree. I think it would make me reflect on the angle that this person is coming from, if that was their response. Are they a holder of certain privileges that maybe lead to them having those views. But I think another thing to be mindful of, at the moment, everything seems extra difficult in the world. We’ve got the cost of living crisis, we’ve got global wars and conflicts going on, which, whether you familiarly or not are related to these places, we’re hearing about all these traumas so often. We are coming out of a global pandemic ourselves. Everyone’s busy. So, everyone feels stretched, even those people who are maybe coming out with that response that you say. So, I think it’s a time that we have to show people even more compassion, which is very difficult when you’re stretched and you’re suffering from all these different traumas and difficult things in life at the moment. But it’s about questioning why those defences are coming up, and why those questions are coming out.  

And that’s something that, again, with the guidance, we expect that to come up. We’ve gone through this ourselves with the anti-racism work and other work that we’re doing. And if that’s your first response, that’s okay.  

HOST: 0:18:58 It’s interesting. The one thing I often talk about is a couple of years ago on this podcast, in fact, I spoke to someone about an SLT drop-in clinic that had been set up in a deprived area that had a high immigrant and refugee population. And nobody used it because they hadn’t thought about how to engage with the community. That’s either where a diversity officer could come in, or if there was an SLT from the immigrant community from that refugee community, then we could ensure that the drop-in clinic was being used. That means it’d be likely to have earlier interventions, better outcomes – especially in, say, bilingual children with speech and language difficulties.  

So, even if you don’t accept the social justice component, there’s an economic argument, for example. And so, I think there are times when the vicious, often completely irrational hysteria of the tabloids, needs to be countered on those grounds.  

And then also, given the severe shortage of staff across the NHS, anything that helps with wellbeing, that helps with retention, reduces attrition, is going to benefit the service, and so, the population as a whole.  

JESS: 0:20:15 There are thousands and thousands of SLT shortages and vacancies at the moment. It’s a very white, female heavy profession. There’s been a lot of work to recruit people from other populations and minorities as well. I’m not going to have the same impact in certain communities as someone else is going to have, and I have to do extra work to learn how to engage with them, which I will do that work. But, as I was saying before, we need to represent everyone that we’re working with.  

KATE: 0:20:48 That’s a really good point, because I know that from the few universities that I link in with and EDI student groups that I’m supporting that there are students in training who share some of our protected characteristics and have others that we can’t speak to that are in training to then become part of our profession. And so actually, if we can create the required safety, I guess, for want of a better word, for people within the profession to be able to speak about their experiences, to be representative of certain experiences, that other people can then see then we, hopefully, over time, and it may be a long period of time, will have a much more diverse workforce, and one that is less white, less cisgendered, leaning more so towards [female 0:21:42].  

It is really, really important that this work is happening and that there is that representation in the same way that we talked about how important that is for the people that we work with who are accessing our services to see another queer person, to see a black person. We also need to have that within the profession. We need to have it in the lecturers cohorts, we need to have it in the service leads, the supervisors, so that people feel that greater safety but also so that we are moving the profession forward and we are opening the doors for a much more diverse workforce over time.  

HOST: 0:22:22 I guess in SLTs there’s a pastoral element to a lot of the work in criminal justice and education. But also, we know clinically it’s important to have diversity; a lack of diversity has caused loads of issues, like the under-diagnosis of autism in women, insufficient pain relief for black woman, higher mortality rates for black woman giving birth. That’s a result of systemic sexism, racism.  

My question then about LGBTQ+. I’m gay, admittedly white cisgendered. My experience of the NHS, both personally as a patient and professionally whenever I work with the NHS, is there’s no trace of homophobia that I’ve encountered, at least. 

My question is, is this issue becoming more acute now because of the increased visibility of trans issues and the increasingly ugly, fractious debates we’re seeing play out in public?  

JESS: 0:23:26 I think it’s an interesting question and an interesting point to be raised because, obviously, trans issues are quite frequently in the media at the moment – more so than in the past few years. And that only highlights that it’s new to us and our thought zones, perhaps. But obviously, for the people with those lived experiences it’s not new for them, they’ve been encountering it all along. And so, it definitely impacts our trans SLTs and trans SLT students. But it is wider than that.  

But perhaps a tangible example I can give you for where that might come into the workforce side of things. In my NHS trust and in many, we have a very strict uniform policy and dress code policy. Ours highlights what the typical male uniform will be and the typical female uniform. Now, in therapy quite often that’s a white tunic with whatever colour piping and a coloured trouser. And for the typical female uniform, it’s ever so slightly tailored in at the waist to accentuate it.  

There are going to be staff members that may not feel safe in disclosing to the line manager or whoever is sorting out the uniforms that whilst they might outwardly be perceived as being female, they might actually prefer the typically male uniform, or actually if there’s a boxy scrub alternative or something else. So, that’s one example where it might show up as an issue for trans or gender nonconforming speech and language therapists, and all staff members, to be honest. That’s all AHPs, doctors as well.  

But yeah, you highlighted is it just a trans issue, because trans issues are big in society at the moment, and that’s certainly not the case. We’ve also had one of our network members approach us and give an anecdote from their placements, where a parent of a child they were working with asked a question about this person’s sexuality and mentioned that their church might be a place that they would like to go. Reading between the lines, this could be insinuated as we can cure you, pray the gay away kind of message that many people have had in their past, present. It’s something that this student was luckily not too impacted by, but their placement educator was not in a place to support them. They kind of laughed it off sheepishly and didn’t actually offer any guidance, counselling, support, or even ask how they felt about it.  

So, we’re hopeful that our guidance that we’re publishing will actually enable the placement educators, the team leads, the students, the peers, the colleagues to be able to have these discussions before they’re ever an issue, but also in reaction to an incident if it ever becomes an issue.  

HOST: 0:26:32 I think that’s really interesting. I think of myself as a fairly informed, progressive queer person, but I wouldn’t think about things like gendered uniforms, and equally dealing with the community, you are going to come across homophobia. So, I could certainly learn from the guidance as well.  

What are the key messages that you would like to leave listeners with?  

JESS: 0:26:52 I think it’s really important for everyone to remember that this is a working piece of guidance. As with everything, it will be reviewed and updated as and when is required. And we invite people to use the audit tool on the zones of practice in a way that fits their service, their team, them as an individual. It is a piece of guidance and there are tools in there that you use as you see fit for you. We’re not prescribing any particular way that it can be used. They’re there and designed to facilitate discussion and learning.  

And the other one we’ve touched on before is that auditing and evaluating how you or your team’s practice or represent or show up for certain groups, be that in an anti-racist or neurodivergent affirming way or LGBT affirming way, it may bring up challenging feelings. And that would be expected, and we invite you to sit with them and think these things through. Why am I having these feelings? Why is it challenging me? Why am I feeling defensive? Lean into it a bit further. Is it because it’s something that you haven’t experienced yourself? Is it because it’s something that you have experienced, actually, and it was really hurtful that you’ve pushed it away? What’s it telling you? Where do you actually need to learn? Where do you need to go and spend more time doing some learning, and where can you get those resources?  

KATE: 0:28:27 I think the only thing that I would add to that is finding community. Even for people who are part of certain marginalised groups doesn’t make you immune to having values and beliefs which can be harmful to those communities.  

In my own practice in trying to work through and dismantle the ableism that shows up within me and my practice, I’ve leant into community, so that’s like-minded therapists who are also wanting to do that work.  

Again, with the anti-racism work, I’ve a few key relationships with other white people where if I noticed something showing up for me, I know I can check in with them and I can basically invite them to hold me accountable, but still supports my learning and my growth to decentre my whiteness.  

Similarly with queer topics. I think if you can find community, a person, a small amount of people that you can connect with, whether that’s in person, verbally, on a Discord server, just through WhatsApp or whatever, but you have that connection and that safety to check in with your learning. And if that’s a shared journey, then great, because you, you know that you can just sense check them of what’s showing up for you, particularly if it’s uncomfortable and you’re trying to confront some of that internalised queerphobia, ableism, racism, classism, etc.  

HOST: 0:29:54 A big thank you to Kate and Jess for their time. As I mentioned at the top of the episode is a link to the guidance in the show notes, as well as a link to the UK SLT Pride Network if you want to get in touch or get involved.  

Until next time, keep well.  

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