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
Centre for Addiction and Mental Health (CAMH)—Other LGBTTTIQ programs, initiatives and partnerships
CAMH offers and is involved with other programs and initiatives for the LGBTTTIQ community. In addition to Rainbow Service substance use and concurrent-disorder counselling, there is a Gender Identity Clinic, a program for co-occurring substance use and mood concerns, a bisexuality and mental health partnership research project, and ongoing partnerships with the trans community. There is also an LGBTTTIQ e-mail listserv for employees, a Health Equity Office (formerly the Diversity Programs Office), and a strategy to promote a safe and inclusive workplace for staff and volunteers who identify as LGBTTTIQ.
For more information on any of these projects, visit www.camh.net/About_CAMH/Guide_to_CAMH/index.html
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:
Sample questions from the assessment guide:
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.