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the potential to influence peer jurisdictions and can translate national competency standards for registered nurses crocband clog to changes at the state and federal levels in a phenomenon called the “snowball effect.

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not all governments explicitly protect people from discrimination on the basis of sexual orientation, gender identity, and gender expression. Even with this complicated landscape, mayors, national competency standards for registered nurses crocband clog county executives, and other officials have the power to enact policy changes that advance LGBTQ equality. These leaders are often responsible for crafting executive budgets that frame debates around the allocation of resources for services that support the most vulnerable residents. They can issue executive and administrative orders that establish policies affecting programmatic, human resources, and operational functions. Under mayors and county executives, department or bureau directors—who report to executives—negotiate questions on program design and evaluation and often work with nonprofit and private organizational partners to leverage external resources to better address unmet needs in communities.

In sum, these leaders and local officials have an array of tools at their disposal that can be used to improve the lives of LGBTQ people and their families. Differences in state laws authorizing the establishment of political subdivisions, including cities and counties, have resulted in the creation of numerous governance structures.6 Many localities have governing structures that centralize executive authority in an elected mayor or county executive. Certain localities require multiple elected officials to share and jointly exercise executive authority. Others elect council members who work with a manager who has executive authorities and is appointed to maintain operations beyond any individual elected member’s term. Mayors, county executives, and other leaders who manage local jurisdictions have the power to take action and make a difference in the lives of LGBTQ people and families. Studies on the diffusion of policy ideas indicate that actions that begin at the local level have