Occupational Therapists may work with people who are lesbian, gay, bisexual, transgender, gender diverse, queer, intersex, asexual, or who use another term to describe their sexuality, gender, sex characteristics or identity.

An LGBTQ+ person seeking or using an assistance animal does not arrive at assessment as a collection of demographic labels.

They may also be:

• a person with disability;
• a child or young person;
• a parent;
• a partner;
• a worker;
• a student;
• a refugee or migrant;
• neurodivergent;
• experiencing homelessness;
• living in a rural or remote community; or
• navigating multiple forms of discrimination or exclusion.

These aspects of identity and circumstance may intersect.

For AAOT practice, LGBTQ+ inclusion matters because assistance-animal assessment involves intimate aspects of everyday life, including home, family, relationships, personal care, community participation, healthcare, work and safety.

The purpose of this topic is not to teach participants a list of LGBTQ+ terminology to memorise.

It is to develop practice that is:

• respectful;
• inclusive;
• non-assumptive;
• privacy-conscious;
• safe;
• rights-based; and
• responsive to the individual’s actual circumstances.

Inclusion Starts With Not Making Assumptions

A practitioner can unintentionally exclude someone before any formal assessment has even begun.

For example, forms may ask only:

Husband / Wife

rather than:

Partner / spouse

A clinician might ask:

What does your mum think?

without knowing who the important people in the person’s life actually are.

A report may use a person’s previous name even though it is no longer appropriate.

A practitioner may assume:

• someone’s gender from appearance;
• someone’s partner’s gender;
• that a person is heterosexual;
• that a person’s family is supportive;
• that gender identity is clinically relevant when it is not;
• or that all LGBTQ+ people have similar experiences.

Inclusive practice begins with a simpler principle:

Do not guess information that you can respectfully ask.

Ask What Is Relevant

An assistance-animal assessment can involve a large amount of personal information.

That does not mean every aspect of the person’s identity needs to appear in the report.

Ask:

Why do I need this information?

For example, a person’s sexuality may be completely irrelevant to an assistance-animal assessment.

At other times, relationship or household circumstances may be relevant because they affect:

• housing;
• animal care;
• safety;
• family support;
• decision-making;
• finances;
• transport; or
• daily routines.

The important distinction is between clinically or functionally relevant information and curiosity.

Collect what is necessary.

Do not turn an OT assessment into an interrogation about identity.

Names, Pronouns and Respectful Communication

People should be addressed using the name and pronouns they ask you to use.

If you are unsure, ask respectfully.

For example:

What name would you like me to use?

and, where relevant:

What pronouns do you use?

Do not make pronouns a spectacle.

They are simply part of respectful communication.

If you make a mistake, correct it and continue.

An extended apology can shift the emotional burden back onto the person.

Documentation Requires Particular Care

Professional records may be accessed by:

• other clinicians;
• organisations;
• insurers;
• funders;
• schools;
• employers;
• legal representatives;
• or government systems.

This means that identity information should be recorded carefully and only where relevant.

Be particularly thoughtful about:

• previous names;
• gender markers;
• sexual orientation;
• relationship information;
• medical history;
• transition-related information; and
• family circumstances.

Do not include sensitive information merely because it came up during conversation.

Ask whether it is necessary for the purpose of the document.

This is especially important in reports that may circulate widely.

Privacy and Safety Can Intersect

For some LGBTQ+ people, disclosure of identity may create real risk.

A person may not be “out” to:

• family;
• an employer;
• a school;
• a service provider;
• a landlord;
• a community group;
• or another professional.

An AAOT should therefore avoid assuming that information disclosed privately can safely be repeated elsewhere.

Before sharing sensitive identity information, consider:

• whether it is relevant;
• whether consent has been obtained;
• who will receive the information;
• whether disclosure could create harm;
• whether the information can be omitted;
• and whether another form of wording would meet the professional need without unnecessary disclosure.

Confidentiality is not just administrative.

It can be a safeguarding issue.

LGBTQ+ Inclusion and Disability

LGBTQ+ people with disability may experience overlapping barriers.

For example, a person may encounter:

• disability discrimination;
• homophobia;
• transphobia;
• inaccessible services;
• assumptions about sexuality;
• assumptions that disabled people do not have intimate relationships;
• poor understanding of gender diversity;
• healthcare barriers;
• family rejection;
• poverty;
• housing insecurity;
• or reduced access to supportive communities.

These barriers can compound one another.

An AAOT should therefore avoid analysing every problem through a single lens.

Sometimes the presenting issue may look like an assistance-animal problem but actually involve a broader intersection of disability, safety, housing, discrimination and participation.

Assistance Animals and Safe Community Participation

For some people, an assistance animal may support participation in:

• work;
• education;
• social settings;
• healthcare;
• travel;
• community activities;
• or daily routines.

However, the person may also be navigating environments where they do not feel safe disclosing aspects of their identity.

For example, an assistance-animal team may draw public attention.

People may ask intrusive questions.

The animal may make the person more visible in environments where they would otherwise prefer privacy.

An AAOT should therefore consider not only the functional benefit of the animal, but also how the intervention may affect:

• privacy;
• visibility;
• social interaction;
• safety;
• confidence;
• and community participation.

For one person, increased visibility may be manageable or even positive.

For another, it may create additional stress or risk.

Do not assume.

Family and Household Relationships

Family relationships can be highly relevant to assistance-animal planning.

An LGBTQ+ person may have:

• supportive family;
• estranged family;
• a chosen family;
• a partner;
• housemates;
• community support;
• or no available family support.

Do not assume that biological family members are necessarily the most appropriate support people.

Likewise, do not assume that estrangement from family means the person has no meaningful support network.

Ask:

Who are the important people in your life?

and:

Who would you like involved in this process?

This aligns closely with the supported decision-making principles covered earlier in AAOT.

Chosen Family

The concept of chosen family may be particularly important for some LGBTQ+ people.

Chosen family can refer to people who function as family through close relationships, support and mutual care even where they are not biologically or legally related.

An AAOT should not dismiss these relationships because they do not fit a conventional family structure.

Where relevant, chosen family may contribute to:

• daily support;
• transport;
• decision-making;
• animal care;
• emergency planning;
• housing;
• financial support;
• or contingency arrangements.

The person’s own understanding of who matters should guide the assessment.

Gender-Affirming Practice and Assistance-Animal Assessment

Gender-diverse people may have particular experiences within healthcare systems.

Some may have encountered:

• misgendering;
• deadnaming;
• inappropriate questioning;
• denial of care;
• assumptions about mental health;
• or professionals focusing on gender when it was unrelated to the reason for the appointment.

An AAOT should not make a person’s gender identity the centre of an assistance-animal assessment unless it is actually relevant.

For example, if a person is seeking an assistance dog for mobility support, the assessment should not become a discussion of gender history unless there is a clear professional reason.

Respectful practice may be as simple as:

• using the correct name;
• using appropriate pronouns;
• keeping irrelevant information out of reports;
• and focusing on the person’s actual occupational needs.

Do Not Pathologise Identity

Sexual orientation and gender diversity should not be treated as disorders.

If a person is distressed, the practitioner should not automatically assume that the distress is caused by being LGBTQ+.

The relevant issues may instead include:

• discrimination;
• family rejection;
• violence;
• unsafe housing;
• social isolation;
• inaccessible healthcare;
• workplace discrimination;
• or other environmental factors.

This again connects with the Human Rights Model of Disability.

Ask:

What is happening around this person?

not only:

What is happening inside this person?

Minority Stress and Environmental Barriers

Some LGBTQ+ people experience repeated exposure to:

• discrimination;
• concealment;
• rejection;
• harassment;
• fear of disclosure;
• microaggressions;
• or social exclusion.

These experiences can affect occupational participation.

An AAOT does not need to become a specialist in minority stress theory to recognise that repeated exclusion or threat can influence how a person engages with:

• healthcare;
• work;
• education;
• community settings;
• housing;
• public transport;
• or professional services.

If a person avoids environments where they anticipate hostility, the occupational issue may not be located solely within the individual.

Rural and Remote Considerations

LGBTQ+ people in rural or remote areas may experience additional barriers such as:

• fewer specialist services;
• limited anonymity;
• fewer affirming healthcare options;
• social isolation;
• transport barriers;
• and concerns about confidentiality in small communities.

These factors may also intersect with assistance-animal support.

For example, a person may need to travel long distances for:

• veterinary care;
• assistance-animal training;
• OT assessment;
• specialist health support;
• or community services.

The appropriate response is not to assume that an assistance-animal pathway is impossible.

It is to assess the actual environment and develop a sustainable plan.

Housing and Assistance Animals

Housing can be particularly relevant.

Some LGBTQ+ people may experience:

• family rejection;
• housing insecurity;
• homelessness;
• temporary accommodation;
• or reliance on informal housing networks.

An assistance animal may complicate access to emergency, temporary or shared accommodation.

An AAOT should therefore consider:

• current housing;
• housing stability;
• animal-care capacity;
• potential relocation;
• legal access questions;
• other animals in the household;
• and contingency planning.

Again, unstable housing should not automatically equal:

not suitable for an assistance animal.

It means the practitioner needs to assess whether the arrangement is realistically sustainable.

Safeguarding and Violence

LGBTQ+ people may experience abuse or violence from:

• intimate partners;
• family members;
• carers;
• housemates;
• community members;
• or others.

An assistance animal itself can sometimes become part of coercive control.

For example, another person might:

• threaten the animal;
• prevent access to the animal;
• refuse veterinary care;
• withhold food or equipment;
• interfere with training;
• or use the person’s dependence upon the animal as leverage.

These issues will be explored more extensively in later safeguarding and domestic and family violence learning.

At this stage, recognise that:

animal welfare + human safeguarding can sometimes be connected.

LGBTQ+ Young People

Where the client is a child or young person, additional care is required.

The young person’s:

• age;
• maturity;
• communication;
• safety;
• family situation;
• privacy;
• and preferences

all matter.

Do not automatically disclose a young person’s identity to family members simply because they are involved in the assistance-animal process.

Nor should you make promises of absolute confidentiality where legal or safeguarding obligations may apply.

Know the limits of your role.

If a situation becomes complex, seek appropriate supervision or safeguarding guidance.

Be Careful With Assumptions About Mental Health

An LGBTQ+ person may also have a psychosocial disability or mental-health diagnosis.

Do not assume that sexuality or gender identity explains the mental-health condition.

Likewise, do not assume that every mental-health issue is unrelated to experiences of discrimination or exclusion.

The correct approach is individualised assessment.

Ask:

What is actually happening for this person?

rather than relying on stereotypes.

Assistance Animals for Psychosocial or Trauma-Related Needs

Some LGBTQ+ people may seek assistance animals for psychosocial or trauma-related disability.

The same principles that apply to every AAOT assessment still apply:

• identify the functional need;
• identify the occupational problem;
• define the proposed task;
• consider alternatives;
• assess expected outcomes;
• consider risk;
• evaluate animal suitability and welfare;
• and ensure the intervention is genuinely wanted by the person.

Do not assume that belonging to a marginalised group automatically establishes a need for an assistance animal.

Equally, do not minimise legitimate disability-related need because a person’s distress may be associated with social experiences.

Inclusive Forms and Administrative Systems

Small administrative choices can signal whether a service is safe and inclusive.

Review forms for assumptions such as:

• only male/female options where more flexibility is appropriate;
• compulsory disclosure of sex or gender where it is irrelevant;
• husband/wife rather than partner;
• mother/father rather than parent/guardian where relevant;
• unnecessary legal-name fields;
• no place to record preferred name;
• or systems that overwrite current names with historical information.

Not every field needs to become elaborate.

The key principle is:

Only collect what you need, and collect it respectfully.

Do Not Put the Person in the Role of Educating You

It is appropriate to ask respectful questions about the individual.

It is less appropriate to expect that person to provide a complete education about LGBTQ+ identities.

If you realise that you lack foundational knowledge:

research it.

Use credible professional and community-informed resources.

Then return to the person for information about their own experience, not for a lecture on an entire population.

Language Changes

Language concerning sexuality, gender and identity evolves.

Different people may prefer different terms.

Some terminology considered respectful in one generation or community may be rejected in another.

A practitioner should therefore remain:

• open;
• curious;
• respectful;
• and willing to update their language.

If you do not know what a term means, it is usually possible to find out without making the client responsible for educating you.

Inclusion Does Not Mean Avoiding Difficult Conversations

Affirming practice does not require the practitioner to agree with every client request.

If there is a professional concern involving:

• animal welfare;
• risk;
• suitability;
• unrealistic tasks;
• environmental feasibility;
• or insufficient evidence,

the AAOT should discuss it respectfully.

LGBTQ+ inclusion means the person’s identity should not result in poorer treatment, stereotyping or unnecessary barriers.

It does not remove normal professional responsibilities.

Interdisciplinary Practice

Depending upon the person’s needs, relevant support may include:

• LGBTQ+-affirming health professionals;
• mental-health professionals;
• social workers;
• legal services;
• housing services;
• family-violence services;
• youth services;
• community organisations;
• advocates;
• veterinarians;
• animal trainers;
• and other allied-health professionals.

An AAOT does not need to become an expert in every aspect of LGBTQ+ health or social support.

Recognising when another service is needed is part of appropriate professional scope.

What This Means for an AAOT

When working with an LGBTQ+ person, consider:

What information is actually relevant to my assessment?

Am I making assumptions about gender, sexuality, relationships or family?

What name and pronouns does the person want me to use?

Am I unnecessarily recording sensitive information?

Could disclosure create a safety or privacy risk?

Who does the person consider family or support?

Who do they want involved in decisions?

Are discrimination or environmental barriers affecting participation?

Could the assistance animal increase unwanted visibility?

Are housing or safety circumstances relevant to sustainability?

Am I pathologising identity rather than assessing the actual occupational issue?

What are the person’s strengths and existing supports?

What are the animal-welfare implications?

What falls outside my professional scope?

Who else might need to be involved?

The goal is not to become an expert in somebody else’s identity.

The goal is to provide respectful, individualised and professionally appropriate assistance-animal Occupational Therapy.

Connecting This Topic to the Rest of AAOT

This topic connects strongly with your earlier foundation learning.

Human rights emphasise equality, dignity, privacy and non-discrimination.

The Human Rights Model of Disability reminds us to recognise environmental and systemic barriers.

Supported Decision-Making emphasises the person’s will, preferences and voice.

First Nations cultural safety reminds us not to assume that our worldview is universal.

Refugee-informed practice reinforces the need to avoid cultural assumptions and unnecessary disclosure of sensitive information.

LGBTQ+ inclusion applies the same broader principle:

Know enough to avoid creating harm, but never assume that a population-level description tells you who the individual in front of you is.

Continue This Topic in Your Reflective Workbook

You have now completed the foundation material for:

Topic 9 — LGBTQ+ Inclusion

Please complete the recommended LGBTQ+ inclusion foundation learning identified in your AAOT Foundation Learning requirements, then refer to the corresponding section of your AAOT Foundation Learning Reflective Workbook.

The workbook will ask you to apply these principles to assistance-animal situations involving:

• inclusive communication;
• names and pronouns;
• privacy;
• unnecessary disclosure;
• chosen family;
• family disagreement;
• gender diversity;
• discrimination;
• housing;
• rural and remote practice;
• safeguarding;
• mental health;
• assistance-animal visibility;
• professional documentation;
• intersectionality; and
• interdisciplinary support.

The purpose is not to test whether you can memorise every acronym or identity label.

We want you to demonstrate that you can practise without unnecessary assumptions, recognise when identity or discrimination is genuinely relevant to occupational participation, protect privacy, communicate respectfully and seek appropriate support when an issue falls outside your expertise.

You may revisit your workbook responses throughout AAOT as your understanding develops. Issues raised here may also contribute to your Capstone Portfolio and Capstone projects, particularly in relation to inclusive service design, accessible documentation, professional education, privacy, housing, discrimination or equitable assistance-animal practice.

Once you have completed or commenced the corresponding workbook activities, continue to Topic 10 — Child Protection and Safeguarding.