Improving LGBTQ+ Veterans’ Whole Health through PRIDE

LGBTQ+ Veterans are at a disproportionate risk for suicide and other poor health outcomes, including discrimination and barriers to care. Although VA requires health care be delivered in an affirming and inclusive environment, a clinical care gap remains.

To answer this critical need, in 2016 a clinician at Hampton VA developed PRIDE In All Who Served (PRIDE), a health promotion group for LGBTQ+ Veterans. Group facilitators follow a session-by-session manual that builds a peer support system while empowering LGBTQ+ Veterans to better navigate the VHA system, reducing health care disparities.

With support from the VHA Diffusion of Excellence program, the team behind PRIDE scaled it to 10 new sites by 2021. Just two years later, PRIDE is now available at more than 50 VA facilities across 26 states, with 18 additional facilities actively adopting the practice.

Critical need for PRIDE

Suicide is the leading cause of death for LGBTQ+ Veterans aged 18-29 and ranked 5th for LGBTQ+ Veterans of all ages. As VA seeks to drive equity for LGBTQ+ Veterans and prevent Veteran suicide, programs like PRIDE are filling critical care gaps and increasing social connectiveness.

This focus on whole health aligns with the VA Under Secretary of Health’s priorities of not only caring for immediate health concerns but also addressing what Veterans need and want by creating an inclusive whole health system of care.  

Building protective factors

PRIDE offers 10 weekly sessions in which Veterans meet for one hour in small groups virtually, in person or in a hybrid format. The curriculum covers topics such as continuums of identity, coming out, healthy relationships, LGBTQ+ families and affirmative care. 

The program provides the opportunity to connect with other LGBTQ+ Veterans and build a support system. Connection and social support provide protective factors against suicide, stigma-related stress and other negative health outcomes for LGBTQ+ individuals.

A Veteran who participated in the program said, “Since coming to the group, I no longer want to kill myself. I have found others who support me.” Another Veteran participant stated, “The group gave me the confidence to come out. It provided a starting point and direction for my next steps in my journey.”

The positive impact of PRIDE

The PRIDE National Diffusion Team, which manages the program and its expansion, carefully tracks metrics. Veteran-reported outcomes include a reduction in likelihood of suicide attempts as well as in symptoms of depression, anxiety and identity stress.

The PRIDE National Diffusion Team routinely evaluates the curriculum as well as Veteran and facilitator feedback to ensure the program continues to meet the needs of LGBTQ+ Veterans.

“One of the most exciting things we get to do is think about the future needs of our LGBTQ+ Veterans since their needs are constantly shifting,” said Heather Sperry, LGBTQ+ Program Manager at Indiana VA. “It’s our job to keep up and evolve with them and shift the content to meet our Veterans’ current needs.”

The PRIDE program has offered six training cohorts so far, including individualized training on how to launch and facilitate the PRIDE groups. The goal is to continue to replicate the program and reach all LGBTQ+ Veterans. PRIDE was recommended as a Clay Hunt SAV Act Best Practice for Suicide Prevention in 2022.

Looking to the future, PRIDE is creating an advisory board with Veterans, clinicians and other stakeholders to offer guidance and expertise as PRIDE makes updates to the manual, clinician training programs and implementation plans. VA wants to be an example of inclusion offering world-class health care to all Veterans.