In 2017, as the U.S. Senate considered President Donald Trump’s proposed ban on transgender people serving in the military, clinical psychologist Nicholas Grant, PhD, was informing the debate with psychological science on transgender identities and discrimination.
As Grant, the 2016 APA William A. Bailey Health and Behavior Congressional Fellow, pointed out to policymakers, health-care professionals agree that identifying as transgender is a normal and nonpathological human variation. And a 2016 studyopens in new window by the RAND Corporation found that allowing transgender people to serve in the military has little to no impact on unit cohesion and medical costs. Now, the fate of the transgender ban is uncertain as legal challenges proceed in several states.
As a congressional fellow, Grant helped draft legislation to condemn discrimination and combat the transgender ban while working on Sen. Kirsten Gillibrand’s (D-N.Y.) legislative defense team, an interprofessional group of staffers and fellows from diverse fields. He also led an intensive "Trans 101" seminar on transgender issues for the senator’s staff—the first such training offered on Capitol Hill.
This sort of collaboration is a mainstay of Grant’s career. Right now, he is doing full-time contract work for the Psychological Health Center of Excellence, a part of the U.S. Defense Health Agency, or DHA, that works to improve the lives of service members, veterans, families and providers by advancing excellence in psychological health care and prevention of psychological disorders.
In addition, in another team-building role, Grant serves as vice president for external affairs on the volunteer board of directors of the nonprofit GLMA: Health Professionals Advancing LGBTQ Equality, formerly known as the Gay and Lesbian Medical Association.
"Nick has been a great voice to draw psychologists and other sociobehavioral health practitioners into an organization that tends to lean more toward medicine," says Laura Hein, PhD, RN, associate professor in the College of Nursing at the University of South Carolina and a former GLMA board member. "Part of his expertise comes from working on behavioral health and LGBTQ issues on Capitol Hill. He’s been able to translate this policy experience to aid GLMA’s advocacy work on similar initiatives."
Bringing psychology to medicine
Grant came to GLMA in 2015. Founded in 1981, it is the world’s largest and oldest association of LGBTQ health-care professionals. The group aims to ensure equity for both LGBTQ patients and practitioners. Since 2002, GLMA has expanded its reach to be more inclusive of nurses, physician assistants, behavioral health practitioners, other health-care professionals and academics.
As the only psychologist on GLMA’s board—an interdisciplinary group of clinicians, administrators and academics— Grant is leading the charge to establish a behavioral health section in an organization that until recently catered primarily to physicians. To that end, he has assembled a working group of 12 behavioral health professionals to explore how a dedicated section can better address their needs. When it launches, the section will elect its own leadership, hold a daylong summit before GLMA’s Annual Conference and disseminate behavioral health resources to its members.
In another effort to bring change agents together, Grant convened more than 30 psychologists, social workers and counselors at the association’s 2018 annual conference to explore trends in mental and behavioral health care, such as integrated care, for LGBTQ patients.
"Nick is leading the discussions about how we can be more responsive to the needs of behavioral health specialists and better address the mental and behavioral health needs of the LGBTQ community," says Hector Vargas Jr., JD, GLMA’s executive director. "His collaborative approach has also helped generate strong support among board members and others of the important role psychology plays in our work to improve the health and well-being of LGBTQ people."
Grant says one of his biggest contributions to GLMA is his commitment to evidence-based decision-making.
"My psychology training and experience have taught me the importance of using evidence to inform every major decision the board makes," Grant says. His time spent working in research, clinical and administrative settings, he adds, allows him to understand the perspectives of diverse board members and help integrate their specialized insights into a broader plan of action.
Prior experience
Before Grant became GLMA’s vice president for external affairs, he served on the board as co-chair of the organization’s Health Professionals in Training committee while completing his postdoctoral and congressional fellowships. After obtaining his doctorate in clinical psychology from Palo Alto Universityopens in new window in 2015, he joined one of his first interdisciplinary teams as a postdoctoral resident at the U.S. Department of Veterans Affairs (VA) San Diego Healthcare System, a role that shaped and inspired the teamwork he does now.
Grant was the sole clinician, administrator and program manager for the VA San Diego Healthcare System’s LGBT Mental Health Program, which enabled him to collaborate with a diverse group of providers across the health system. In his work with transgender veterans, he provided individual and group psychological services and worked alongside endocrinologists who administered hormone therapy, speech pathologists, physicians and nurses to provide affirming care.
He also was a member of the San Diego VA’s LGBT Work Group, where he teamed up with nurses, psychiatrists, social workers and administrators to improve the overall care experience for LGBTQ veterans. Among their projects was helping to develop an evidence-based training program for health-care providers on caring for LGBTQ veterans.
"When we talk about things like identity, stigma and discrimination, the way that we measure those is through psychological science," Grant says. "At the VA, I was able to educate providers and patients about LGBTQ health concerns because so many of these disparities are psychologically driven."
Grant educated patients and providers throughout the health system about health disparities LGBTQ patients face, as well as on how discrimination and family rejection contribute to anxiety, depression and suicide. He also taught providers about the need to offer affirmative services and to avoid language that makes assumptions about a patient’s sexual or gender identity—for example, instead of asking about a male veteran’s wife or girlfriend, providers should ask about the veteran’s partner.
At the VA, Grant also helped providers learn to work with patients’ multiple and intersecting identities. LGBTQ veterans have unique needs, he says, which stem from stigmas they may have faced both during and after military service.
"Everyone in the work group offered different perspectives. People always understood their role but were really happy to collaborate and learn from one another," he says.
Next steps
Now, Grant is continuing to educate others on evidence- based practice through his work as a clinical psychologist subject matter expert for Salient CRGT Inc., a technology firm supporting the DHA’s Psychological Health Center of Excellence, where he works on another interdisciplinary team that creates clinical support tools for providers, veterans, service members and their families. As a contractor for the organization, Grant helps develop clinical reference tools and electronic resources to communicate the latest research on treating psychological conditions such as depression, substance use and post-traumatic stress disorder.
Meanwhile, he is applying the skills gained in his day-to-day work with politicians and LGBTQ patients as a newly appointed member of D.C. Mayor Muriel Bowser’s LGBTQ Advisory Committee. The committee develops and leads local initiatives, such as efforts to support older adults who are homeless or incarcerated. Grant will offer insights from psychological research and advice on effective program development and implementation.
"I believe that my past experiences and training working with interdisciplinary teams will help me advance policy-change efforts like those of the LGBTQ Advisory Committee," Grant says. "This is an opportunity for me to ensure that psychological research helps inform the development and use of supportive programs and policies for the LGBTQ community."
"Psychologists on the Team" is a regular feature in which the Monitor explores the work of psychologists on interprofessional teams.
