SF LGBT data collection a work in progress

The collection of LGBT demographic data by various San Francisco city departments continues to be a work in progress a year after the agencies were required to track such information.

According to reports filed by five city agencies, and shared with the Bay Area Reporter this week, work continues on updating the computer systems the departments are using to ensure they include questions about a person's sexual orientation and gender identity, or SOGI for short. In addition, the reports indicate that asking about gender identity has proved to be particularly complicated.

"I think the rollout has been challenging for some departments more than others, primarily because they are working across multiple different systems and platforms, some of which are state level and haven't quite integrated the state-level SOGI requirements," said Clair Farley, director of the city's Office of Transgender Initiatives, which has been working with the departments on how to best collect the SOGI data. "Others tried to pilot it small so it was more manageable."

As the B.A.R. detailed in a three-part series last summer, six city departments began using forms in 2017 that asked the SOGI questions. LGBT advocates argue the collection of such data is needed to gain better insight into the health needs and other issues confronting the LGBT community.

The information, they argued, was needed in order to ensure there was adequate funding for programs and services that address the needs of the LGBT community. State lawmakers followed suit by also ordering a number of California departments and agencies focused on health care and social services to begin collecting SOGI data as of this July. Additional state agencies will begin asking the SOGI questions on their forms next summer.

"At a time when the federal government is ending data collection about LGBT people, it is critically important that San Francisco continues to ensure that LGBT residents count," City Administrator Naomi M. Kelly told the B.A.R. this week in a statement.

Last Thursday, as the B.A.R. was first to report, San Francisco Mayor London Breed ordered all city agencies and departments that collect demographic data to update their forms, both paper and electronic, so that they include the option of nonbinary in addition to male and female when asking about gender identity. Breed's order came in response to media reports that the Trump administration is preparing a proposal to limit the identification of a person's gender to include only "male" or "female" that is listed at birth.

The mayoral directive, which took effect immediately, also ordered that the forms expand on title options beyond Mr. and Ms. and include additional choices for pronouns other than just she/her/hers and he/him/his. The forms must also include a line for a person's chosen name and use gender-neutral labels such as "parent/guardian" instead of "father" and "mother."

"Here in San Francisco, we stand in strong support of our transgender and gender-nonconforming residents," stated Breed in announcing the new policy. "This executive directive is about celebrating the diversity of our communities and building a more inclusive city for all."

The city in 2016 adopted the SOGI collection requirements, introduced by gay former supervisor Scott Wiener, based on a recommendation from an LGBT aging policy advisory body. Since then, Kelly said her office has "been committed to working hand-in-hand with the city's covered departments to better collect SOGI information to prevent LGBT health disparities and improve services to LGBT youth and seniors. I look forward to the continued work from everyone involved in this process to help inform the Board of Supervisors as they make budget and program decisions."

As of July 1, 2017 the collection of SOGI data became a requirement for the Department of Public Health; Mayor's Office of Housing and Community Development; Department of Human Services; the Department of Aging and Adult Services; the Department of Children, Youth and their Families; and the Department of Homelessness and Supportive Housing. Contractors that receive more than $50,000 a year in city funds are also required to collect the SOGI data.

Fitful rollout of SOGI questions
It has been rolled out in fits and starts, according to the department reports shared with the B.A.R. The main issues the departments have grappled with are the training of staff on how to ask the SOGI questions, the wording of the questions related to gender identity, and updating the electronic record systems being used.

"We started learning about the challenges and obstacles right away," said Farley, who took over the mayoral adviser role in December. "I think, overall, all the departments we worked with were really positive and understood the purpose behind it. There has been a lot of work on the backend across departments to try to push this forward despite the challenges."

For instance, the Department of Homelessness and Supportive Housing is still phasing in the rollover to its new Online Navigation and Entry System, known as ONE. It reported needing to add its adult shelters, Navigation Centers, and locally funded housing programs to ONE. Initially expected to be complete by this December, the department said it had to push back the timeline "due to some changing departmental priorities."

It noted in its report that "SOGI data collection implementation would be more efficient if providers and staff were trained on a single system that was built out to collect this data."

All new users of the ONE system are being trained on how to collect the SOGI data, said the department. And it is working with the city's health department, which it shares data with, on how to ask about gender identity, which requires a two-part question inquiring about a person's current gender and the one they were assigned at birth.

"HSH will work on training providers collecting SOGI data to ensure that data collection is done in a safe and non-intrusive way," stated its report.

Doing so will be of critical importance when the department conducts its 2019 Point-in-Time Count of the city's homeless population. The 2017 count found that 30 percent of homeless survey respondents identified as LGBTQ, and the department will be reviewing next year's data to see if it is underrepresenting the LGBTQ population.

"Serving this population is a key focus of our department and HSH will continue to ensure that all programs are more accessible to LGBTQ individuals who are eligible for those services," stated its report.

The Department of Children, Youth and their Families noted it worked with its vendor, Cityspan, last year to update its contract management system to include SOGI questions. The agency does not collect demographic data, and instead, leaves it up to its grantees to do so.

But because there are still questions on how best to capture SOGI data for those clients under the age of 18, the department opted to only require grantees that work with transitional age youth, 18 to 24 years old, to start asking them about the SOGI questions. It added that it continues to look for "appropriate models and methods" to collect SOGI data of clients "that address issues of confidentiality and consent."

Farley explained that the issue with asking youth under the age of 18 the SOGI questions is often their parents or guardians are the ones who fill out the forms and the city does not want the youth to have to out themselves to their family.

"If a form requires a guardian to fill it out or sign it, it can oftentimes put people at risk if they aren't out to their families," she said.

In its report, DCYF noted there continues to be holes in the SOGI data collected by its grantees of the 1,034 TAY clients they serve. Of the 611 TAY clients that had valid sexual orientation responses, more than a third said they were members of the LGBT community, while 9 percent of 732 TAY clients with valid answers on their gender identity questions said they were transgender.

The agency pledged to improve SOGI data collection efforts in the 2018-2019 fiscal year, as it recognizes that "better SOGI data will help the department paint a more complete picture of how well LGBT communities are being served by DCYF-funded programs."

But, in working with Farley's office on the issue, it reported it would no longer have grantees ask what sex people were assigned at birth. Asking about that information, it reported, "may provide undue burden to participants" and isn't "necessary in a non-medical context."

The mayor's housing office also reported it had made changes to how it asks SOGI questions, adding a "decline to answer" option when it comes to the sex-at-birth question. It also was given a partial waiver this fiscal year in collecting the sex-at-birth data from its applicants and clients.

Farley told the B.A.R. that the sex-at-birth question is primarily of benefit for health care reasons and wasn't needed necessarily for evaluating if other city services are accessible to the LGBT community.

"The majority of the community feedback we are getting is if you are not speaking to a medical provider then answering questions about your sex at birth felt really invasive," she said. "We are finding it doesn't make sense to ask it across the board."

As the B.A.R. noted in its series last year, the health department focused on training all of its staff on how to ask the SOGI questions as it worked to update its medical records and intake forms. It reported having now trained 8,000 employees and continues to offer additional support as needed.

It found that just 12 percent of those asked the SOGI questions declined to answer them. Its goal, according to its report, is to have at least 60 percent of its 93,000-plus patient population in the San Francisco Health Network complete the SOGI questions this fiscal year.

"As we approach this higher number, we'll start to examine health outcomes for disparities among minority orientations compared to heterosexually identified patients and among gender expansive patients compared to cisgender patients," it stated. "Armed with data for the first time, SFHN can begin to ensure health equity for LGBT patients."

The city's Human Resources Agency reported that it is still rolling out SOGI collection across its vast agency, which includes three separate departments serving more than 200,000 San Francisco residents. It also noted that the questions and responses about SOGI its record system uses do not align with those used by the city health department.

"While HSA has worked very hard to comply with the ordinance, there is still work to be done in some areas," it stated in its report.

It also noted that the SOGI data so far collected "is not yet high enough" in quality that it can be analyzed "to the extent to which LGBT individuals are under or overrepresented or underserved."

The report did highlight the Department of Aging and Adult Services as being "at the forefront" of collecting SOGI data. But even that agency encountered issues, it noted. For instance, the San Francisco Adult Protective Services had some "technical issues with compiling 'sex at birth' data."

It did find that of the 5,180 adults it serves, 241 said they were gay, lesbian, or same-gender loving, while 45 identified as bisexual. Nine people said they were nonbinary and 22 said they were transgender.

The city's In-Home Supportive Services program uses a state-based computer system that was not required to update its forms with SOGI data until July of this year, so it is just beginning to ask such questions, according to the report. The Public Guardian and Public Conservator programs have also seen their efforts to ask about SOGI delayed as they update their intake systems.

The aging department's other programs have had better success in collecting SOGI data. It is finding that LGBT seniors underutilize the city services that are available compared to heterosexual seniors. Other county aging departments have been contacting the San Francisco agency to train their staffs on how to ask about SOGI.

"After one year of asking these questions, we have found that making sure people are well trained is extremely important," said Tom Nolan, a gay man who is manager of special projects at the city's aging department, during a recent forum about creating a statewide aging plan that includes the needs of LGBT older adults.

But issues remain, noted Karyn Skultety, Ph.D., executive director of Openhouse, a nonprofit provider of LGBT senior services.

"It hasn't been easy breezy," said Skultety, who is bisexual, at the forum. "The reality is people are uncomfortable in asking the question, so we are still struggling to get that information here."

The reports from the city departments were shared with members of the Board of Supervisors Tuesday afternoon. Gay District 8 Supervisor Rafael Mandelman told the B.A.R. he would likely call for a hearing to discuss the reports in early 2019.

Farley is looking to see if any legislation is needed to ensure Breed's directive from last week is fully implemented. And her office will be working closely with the city departments on analyzing the second year's worth of SOGI data that is collected to see how the needs of the LGBT community can be better addressed.

"I think this continues to be a work in progress, so we are looking at this as a pilot year. We are learning a lot from it," she said. "Our office continues to train agencies and grantees. Without additional training, this will continue to be a challenge."

Contact the reporter at m.bajko@ebar.com.

[This story was originally published by Bay Area Reporter.]