Breaking Down Barriers to Inclusive Care for LGBTQ+ Children and Young People in Children’s Health Ireland (CHI)

June is Pride Month, a time to celebrate the LGBTQ+ community and reflect on how far we’ve come, and how far we still have to go. Behind the bunting and flags is a sobering truth: LGBTQ+ adolescents in Ireland face significantly poorer mental health outcomes than their peers. In Children’s Health Ireland, Associate Professor Dani Hall leads the Rainbow Badge Initiative. Here she, and the Rainbow Badge team, a passionate group of clinical and non-clinical staff, tell us about the work they’re doing in breaking down barriers for LGBTQ+ children and young people.

At Children’s Health Ireland (CHI), we meet young people at some of the most vulnerable moments in their lives. We see their strength, their fear and their questions. We have a responsibility to meet each of them with compassion, dignity, and understanding. For the 13% of Irish young people who identify as LGBTQ+, that responsibility takes on added weight. Many arrive at our doors already carrying the burden of stigma and silence. Their mental health outcomes are significantly worse than their peers: they are three times more likely to experience depression or self-harm, and five times more likely to attempt suicide. Most heartbreakingly, the most common age of attempted suicide is just 15.

For some, we may be the first healthcare professionals they encounter. And the stakes are high. LGBTQ+ adolescents in Ireland have said they worry that healthcare staff will judge them. That fear alone can be a barrier to care, especially in moments of crisis. We wanted to understand how we could do better; how we could make sure our hospitals are not just medically excellent, but genuinely inclusive, safe, and affirming spaces for every young person who walks through our doors.

That’s what led us to our first research study. We asked doctors, nurses and healthcare assistants working in CHI’s emergency and urgent care departments how prepared they felt to care for LGBTQ+ young people. Using a validated research tool called LGBT-DOCSS, we found something important. While staff had strong, positive attitudes, many felt only moderately informed, and even less clinically prepared, particularly when caring for trans young people. Positive intent alone wasn’t enough. We needed to build confidence, deepen understanding, and translate good will into better care.

We also knew our staff were stretched. It was the depths of the COVID pandemic, and the HSE had just suffered a cyberattack. Any solution had to be realistic, fast, and accessible. So we developed an online educational package made up of three parts: a 40-minute HSELanD e-learning module, a four-minute blog post hosted on the Don’t Forget The Bubbles website, and a seven-minute YouTube video. Less than an hour of education in total. We then invited the same staff to repeat the LGBT-DOCSS survey two weeks and then three months later.

In just two weeks, staff reported improved knowledge, more positive attitudes, and, most crucially, a stronger sense of clinical preparedness to care for LGBTQ+ young people. These weren’t just small gains; the biggest improvement was in staff feeling more ready to support the young people in their care. Even more encouraging was what happened next. Three months later, the scores continued to rise. Staff told us they had started to change the way they spoke with young people, to notice their own assumptions, and to seek out further learning on their own. Many said they simply felt more confident, more able, to offer inclusive, affirming care to those who needed it most.

What began as a small education initiative was creating meaningful change in everyday practice.

Building on this, we introduced the HSE Rainbow Badge to CHI. More than just a symbol, the badge represents a commitment. Staff who wear it have opted in, completed training, and signed a pledge to be allies in healthcare. Three years later, over 2,000 CHI staff have taken that step. In our follow-up research we asked staff about their experiences in wearing the badge.

The feedback from staff has been deeply moving. Many describe the badge as a quiet but powerful message of trust. LGBTQ+ staff have said they feel more accepted when they see others wearing it. Overwhelmingly, our staff spoke about the sense of pride they feel in wearing it: pride in being part of something that supports young people, pride in being visible allies, and pride in working in a culture where LGBTQ+ staff and patients alike feel accepted and safe.

This work has already had real impact, recognised through three national awards, a growing annual CHI Pride Conference, and a vibrant community of staff who are driving change from within. And we’re not done yet. We’re now partnering with Belong To, Ireland’s national LGBTQ+ youth organisation, to co-design the next phase of research. Together, we’ll be holding focus groups with CHI staff and LGBTQ+ young people to listen, learn and keep improving the care we provide.

If you’re a member of CHI staff and you’d like to be part of this journey, there are a few ways to get involved. You can sign up for a Rainbow Badge at www.bit.ly/CHIrainbowBadge.

We also hold an annual CHI Pride Conference, CHI Pride Matters. This year, it was held on Monday 23rd June, from 9am to 1pm, at Trinity School of Nursing.

Our agenda was jampacked with keynote speakers including:

• Welcome from Dani Hall, Consultant in Emergency Medicine, Director of Simulation & Clinical Lead for the Rainbow Badge in CHI
• Inclusive care in CHI from Lucy Nugent, CEO of Children’s Health Ireland
• Seeing the Rainbow Badge: A Personal Reflection from Kai Bronson
• Promoting inclusion from within CHI, Sheelagh Cave, candidate Advanced Nurse Practitioner in Emergency Medicine in CHI at Crumlin
• Removing the taboo around LGBTQ+, Britanny Hogan, Professional Athlete
• The Mental Health Commission: Empowering staff in CHI, Kate Keenan, Senior Registrar in Child and Adolescent Psychiatry, CHI at Temple Street
• Rainbow Badges Won’t Save Us: Confronting the Real Barriers to LGBTQ+ Health Equity, Johnathan Gilmore, Assistant Professor & Head of General Nursing at the University of College Dublin
• Equality for Children, Renae Von Meding, CEO of Equality for Children
• Community Connection, Agnes Higgins, Professor in Mental Health at Trinity College Dublin & Sinéad Keane, Deputy of CEO & Director of Communications and Advocacy of Belong To
• Bringing it home in the new children’s hospital, Tracey Wall, Directorate Operations Lead CDA, CHI at Temple Street

This work has shown us something powerful: when we equip staff with the tools they need, they respond with heart, compassion and lasting change. Together, we’re building a CHI that truly sees and supports every young person, exactly as they are.

Keep Caring With Pride,

The CHI Rainbow Badge Team

The HSE Rainbow Badge in CHI is championed by a group of clinical and non-clinical staff: Dani Hall, Dee Shanahan, Anne Kehoe, Warren O’Brien, Jacquie Lyons, Sheelagh Cave, Pam Doyle, Aidan Quinn, Jenny Campbell, Tara Finglas, Emma Foster, Patrick Fitzpatrick, Sheena Durnin, Sinead White, Seán Morris, Seán Kelleher, Helen Grant, Dani McCollum and many others.

Kelleher ST, Barrett MJ, Durnin S, Fitzpatrick P, Higgins A, Hall D. Staff competence in caring for LGBTQ+ patients in the paediatric emergency department. Archives of Disease in Childhood 2023;108:525-529.

Kelleher ST, Barrett MJ, Durnin S, Fitzpatrick P, Higgins A, Hall D. Improving clinical competence with LGBTQ+ patients in the paediatric emergency department: an education intervention study. Archives of Disease in Childhood 2024;109:173-174.

O'Dwyer C, Kehoe A, Shanahan D, O’Brien W, Hall D. Staff experiences of wearing the Rainbow Badge in a paediatric hospital setting: a mixed-methods survey. Archives of Disease in Childhood 2024;109:422-427.