It’s All About ‘Asking the Right Questions’

Marcia Gibson, BA, MEd

Reprinted from "LGBT" issue of Visions Journal, 2009, 6 (2), pp. 24-26

Asking the Right Questions 2 (ARQ2) is both a highly successful assessment tool and a one-day training session. The assessment tool provides clinicians with a helpful guide for beginning discussions on sexual orientation and gender identity. It’s for use with clients in mental health, counselling and addiction settings.

ARQ2 was developed at the Centre for Addiction and Mental Health (CAMH) in Toronto. CAMH is Canada’s largest mental health and addiction teaching hospital, fully affiliated with the University of Toronto. It’s one of the world’s leading research centres and has been recognized as a Pan American Health Organization and World Health Organization collaborating centre. CAMH combines clinical care, research, education, policy development, prevention and health promotion to transform the lives of people affected by mental health and addiction issues.

The ARQ2 training provides service providers with an orientation to the assessment tool, focusing on:

  • key definitions and concepts to do with lesbian, gay, bisexual, transgender, transsexual, two-spirit, intersex and queer (LGBTTTIQ) people

  • unique issues of concern to LGBTTTIQ people

  • health impacts of heterosexism (the belief that opposite-sex relationships are superior) and genderism (the belief that one gender is better than others)

  • ways that organizations can better meet the needs of these diverse communities

Intake: sexual orientation and gender identity are relevant

ARQ2 was initially created in 2001 by staff in CAMH’s Rainbow Service, a specialized addiction program for LGBTTTIQ clients. Staff had recognized a need for a set of standardized questions to improve the CAMH Addictions Program’s general intake and assessment process.

LGBTTTIQ clients were having difficulty accessing Rainbow Service. Clients told staff that they were never asked about their gender or sexual orientation during the assessment process. And they often felt unsure or unsafe about disclosing their sexual and gender identities. As a result, clients weren’t referred to Rainbow Service and often experienced homophobia or felt alienated in addiction groups they did join.

To help fix this, Rainbow Service researched questions for clinicians to ask clients during the addiction assessment process. They developed a manual and a one-day training, Asking the Right Questions (ARQ), for CAMH assessment staff. The manual and training were then modified to include mental health assessments, and the acronym ARQ2 was officially adopted.

Teaching ARQ2: increasing LGBTTIQ awareness

The ARQ2 training was so popular that in 2004, CAMH established the ARQ2 Project as part of a five-year diversity priority plan. This plan aimed to promote the specialized ARQ2 training and to build capacity by training trainers located throughout Ontario. The project’s effectiveness would also be evaluated.

Project results were very encouraging. Nine experts from around the province joined CAMH’s four-member training team. These new trainers are members of, and knowledgeable about, their local LGBTTTIQ communities. They are also experienced in clinical group facilitation, training and/or other clinical work.

The 13 trainers paired up to facilitate 44 training sessions throughout Ontario. More than 1,200 participants were encouraged to increase their comfort, knowledge and skills in working with LGBTTTIQ clients. Participants included front-line workers in community service settings, hospital social workers, high school guidance counsellors and therapists in private practice.

As part of the ARQ2 evaluation plan, follow-up interviews were conducted with a random selection of participants who had agreed to be interviewed. The feedback was consistently positive. Three months after attending the training, a majority of the 30 participants surveyed were applying components of the training to their work. They felt that ARQ2 raised their awareness, made them more open and sensitive to the issues, and gave them a language with which to speak to clients. Moreover, participants felt that ARQ2 training should be standard for all front-line workers and expanded to all levels of organizations.

This success of ARQ2 is due, in large part, to the ARQ2 trainers. As engaging and knowledgeable facilitators, they bring a wealth of experience and passion to their work. They bring the training and manual to life!

The ARQ2 manual can be ordered from CAMH or downloaded free of charge from the CAMH website. For more information about this resource and the training, visit www.camh.net/Publications/Resources_for_Professionals/ARQ2.

The ARQ2 Assessment Manual*


The manual includes:

  • an assessment guide on when and how to identify a client’s sexual orientation and gender identity and asking about related concerns

  • background information to help therapists, counsellors, nurses, doctors and other clinicians use the ARQ2 guide

  • answers to questions from therapists and counsellors

  • a list of resources

  • a glossary to help therapists and counsellors become familiar with terms that may be used by LGBTTTIQ clients and communities

Sample questions from the assessment guide:

  • How would you identify your sexual orientation?
    __ straight/heterosexual  __ lesbian  __ gay  __ WSW (woman who has sex with women)
    __ bisexual  __MSM (man who has sex with men)  __queer
    __ transensual (person attracted to transsexual or transgendered people)
    __ polysexual  __ two-spirit  __questioning  __ asexual □ autosexual
    __ unsure  __ other_____________  __ prefer not to answer

  • Do you have concerns related to your sexual orientation, or do you ever feel awkward about your sexual orientation?
    __ not at all  __ a little  __ somewhat  __ a lot  __ unsure  __ prefer not to answer

Sample text from the background information related to this question:

“There is a broad spectrum of sexual orientations. One way to think about sexual orientation is as a fluid continuum that ranges from exclusive same-gender attraction to exclusive opposite-gender attraction, with many points in between."

“It is important to note that not everyone who identifies as the same sexual orientation will fit in the same place on the continuum. For example, one bisexual person may fit directly in the middle of the continuum, but another bisexual person may fit away from the middle and closer to one end of the continuum than to the other.”

 
About the author

Marcia is a Provincial Services Program Consultant with the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario. She currently leads the Asking the Right Questions 2 (ARQ2) provincial project and coordinates a number of other diversity and health care access initiatives.

*The ARQ2 Assessment Manual

Barbara, A.M., Doctor, F. & Chaim, G. (2007). Asking the right questions 2: Talking with clients about sexual orientation and gender identity in mental health, counselling and addiction settings. Toronto: Centre for Addiction and Mental Health. www.camh.net/Publications/Resources_for_Professionals/ARQ2/arq2.pdf.

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