Understanding and addressing the unique needs of special populations

In the behavior change field, participant engagement is essential for successful outcomes. Engaging participants can also pose persistent challenges for providers. To help engage participants, you’ve likely heard the phrase “meeting people where they’re at.” Popular for a reason, “meeting people where they’re at” involves tailoring facilitation to participants’ knowledge, experience and perspective. Meeting the unique needs of your participants is key to increasing engagement and ensuring successful outcomes. This is especially important when working with special populations whose life experiences, cultural backgrounds and social identities shape their histories and journeys of change and healing.

Learn more about what influences treatment engagement →

What are special populations?

Special populations include groups that face unique challenges and systemic barriers. These disparities can make it harder for these individuals to engage in and benefit from interventions aimed at behavior change. Members of the LGBTQIA+ community, veterans, incarcerated individuals, racial and ethnic minorities, disabled individuals, and those with substance use disorders or mental health conditions are all examples of special populations. 

What is cultural humility? 

By cultivating cultural humility, empathy and adaptability, facilitators can foster a safe and inclusive environment that promotes positive change for every participant. 

Cultural humility means being “respectful and considerate of the other; being genuinely interested in, open to exploring, and wanting to understand the other’s perspective; not make foreordained assumptions; not acting superior; and not assuming that much is already culturally known about the other” (Hook & Watkins, 2015). 

As people learn, grow, age and experience life, they develop their own understandings of the world around them. Most people develop biases based on their own understanding and experiences with a variety of subjects in life. What is important — especially in facilitating at-risk and marginalized groups — is recognizing when these biases are harmful; working to overcome them through empathy, compassion and understanding; and putting in the effort to be an impartial facilitator, if not an advocate or supporter. 

Exploring the importance of cultural humility →

Practicing trauma sensitivity 

Special populations, including those with mental health or substance use disorders, individuals with disabilities, racial and ethnic minorities, LGBTQIA+ individuals and justice-involved individuals, are disproportionately affected by trauma. Facilitating trauma-sensitive, culturally humble programs is especially important to engage and effectively serve these individuals, leading to successful outcomes.

Facilitating trauma-sensitive programs requires not only a foundational understanding of trauma and its effects, but also a commitment to creating a space where all participants feel seen, heard and valued.

It may be helpful to note that trauma can also be bidirectional in special populations. For instance, trauma can be a risk factor for substance use, and substance use a risk factor for trauma. Individuals with mental health disorders are more likely to have a history of trauma, and trauma increases the risk of individuals develmyoping mental health disorders and psychiatric symptoms. Those with co-occurring conditions (both a substance use disorder and mental health disorder) also experience this bidirectional risk.

This list is by no means exhaustive. Tuning in to your participants and being sensitive to their unique challenges and needs will allow you to offer individualized care. Cultural humility and trauma sensitivity are the cornerstones of working with any special population.

LGBTQIA+ individuals

Unique challenges:

• Trauma related to societal stigma, rejection, hate crimes/violence, accessing medical care, etc.
• Struggling with identity and self-acceptance.
• Marginalization within the LGBTQIA+ community (e.g., racism, ableism or ageism; bisexual or nonbinary erasure, leading to feelings of invalidation; exclusion of asexual individuals and other minority groups within the LGBTQIA+ community; etc.)
• Intersectional experiences (e.g., LGBTQIA+ individuals of color, with disabilities or barriers related to economic or immigration status, etc.)
• “Outing” and loss of privacy (having one’s identity revealed without consent).
  Religious or spiritual affiliation and subsequent challenges with identity and coming out.

Facilitation considerations:

• Ensure inclusive practices and language.
• Cultivate an affirming environment.
• Validate unique experiences and challenges.
• Monitor group microaggressions or biases.
• Provide education to group members on LGBTQIA+ challenges.
• Provide LGBTQIA+-specific resources and support.
• Recognize the importance of confidentiality — some may not be fully “out” and fear disclosure. 

Transgender individuals

Unique challenges: (in addition to those above):

• Prevalence of complex trauma (e.g., family rejection; physical, sexual and emotional abuse; systemic marginalization; etc.)

• Limited access to gender-affirming healthcare, including mental healthcare.

• Limited ability to transition; fear of not “passing” as their gender; internalized transphobia.

Facilitation considerations (in addition to those above):

• Use chosen names and preferred pronouns (if in doubt, you might ask, “Which pronouns do you prefer?”)

• Acknowledge mistakes in using chosen names and preferred pronouns but do not dwell on it.

• Educate group members on diversity and respect.

• Create a trauma-informed, culturally humble environment.

Individuals with disabilities
Unique challenges:

• Ableism (including stereotypes about their abilities and contributions, exclusion from activities perceived as beyond their capability, etc.)

• Trauma linked to their disability (e.g., directly, including accidents or violence that led to a disability; or indirectly, including medical trauma, neglect or abuse).

• Communication and cognitive challenges.

• Dependency on institutional support (assistive devices, medication, etc.)

• Power imbalances, which may lead to exploitation.

Facilitation considerations:

• Provide an accessible environment and accommodations.

• Modify activities to accommodate physical, sensory or cognitive needs.

• Offer materials in accessible formats and language.

• Promote an environment of safety and trust.

Additional populations to consider

• People of color and ethnic minorities: Unique trauma often faced by these populations includes racism, systemic oppression, hate crimes and historical injustices. They may distrust or fear authority figures and the system as a whole. 

• Justice-involved individuals: People who are or have been incarcerated often face trauma from violence, abuse or neglect within the correctional system. Many have experienced poverty, substance use disorders or adverse childhood experiences prior to incarceration. The prison environment can contribute to further trauma through isolation, lack of safety and exposure to violence. They may struggle with distrust of authority figures and systems, as well as stigma and difficulties reintegrating into society upon release.

Explore evidence-based, behavior change curricula for individuals experiencing incarceration →

• Women and survivors of female-specific trauma: Women have often experienced intimate partner violence, sexual assault or harassment. They may have PTSD and associated fear or distrust of men as a result. 

Discover our gender-responsive Trauma in Life program →

• Men and survivors of male-specific trauma: Men may face stigma around expressing vulnerability or seeking support. They often struggle with societal expectations of masculinity. This may be especially true if a man has experienced sexual assault, intimate partner violence or abuse by a family member or someone close to them. 

• Military veterans: It isn’t just combat that can cause trauma among veterans. Military sexual trauma, training exercises and military culture can also be traumatizing. They may also struggle with transitioning back into civilian life and its authority hierarchy.

Explore curricula for veterans transitioning to civilian life →

Meeting people where they are is a skill you can build and strengthen over time. Building a culturally humble, trauma-sensitive program can offer your participants a safe space to engage, share and learn, fostering lasting change efforts.