A Blueprint for Planning and Implementing a Transgender Health Program (original) (raw)
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Journal of urban health : bulletin of the New York Academy of Medicine, 2015
This report describes the evolution of a Boston community health center's multidisciplinary model of transgender healthcare, research, education, and dissemination of best practices. This process began with the development of a community-based approach to care that has been refined over almost 20 years where transgender patients have received tailored services through the Transgender Health Program. The program began as a response to unmet clinical needs and has grown through recognition that our local culturally responsive approach that links clinical care with biobehavioral and health services research, education, training, and advocacy promotes social justice and health equity for transgender people. Fenway Health's holistic public health efforts recognize the key role of gender affirmation in the care and well-being of transgender people worldwide.
Transgender Health
Transgender individuals experience barriers accessing primary care. In Ontario, primary care is delivered through a variety of delivery models. Literature supports team delivery of primary care for transgender individuals, yet little is known about care delivery in Ontario and the role of primary care teams. We intend to explore how primary care for transgender individuals is delivered within the different primary care models in Ontario and the roles primary care team members enact in care delivery, barriers, enablers, and clinical competence of practitioners in delivering transgender care. Methods: Case study methodology was used to compare transgender care across three Ontario primary care models. Key informants identified cases known to provide transgender care for case selection. Qualitative interviews were conducted. Documentary evidence and field notes were collected. Results: Practitioners clearly articulated their role and activities they were responsible for in providing care, however, they tended to work independently. In cases with an interdisciplinary team there was limited collaboration. Nurse practitioners, physicians, and counselors contributed most to the delivery of care. Key challenges included lack of service coordination within organizations, and the need for practitioner education. Continuing educational sessions, guidelines, and mentorship aided capacity building. Conclusions: Providing primary care to transgender individuals is within the scope of practice for primary care practitioners and can be part of routine care delivered in different models of care. Primary care team collaboration can be strengthened by regular team meetings. Professional training needs to include transgender education and continuing education opportunities need development.
Improving Health Care Encounters and Communication With Transgender Patients.
J Comm Healthcare: Strategies, Media and Engagement in Global Health 2014;7:25-40.
Transgender persons represent a generally ill-served or underserved population. This marginalized group continues to experience considerable difficulty in obtaining culturally competent health care despite recommendations by professional organizations and introduction of antidiscrimination legislation. This review examines communication and procedural barriers to transgender health care and suggests practical steps to help ameliorate disparities and unequal treatment. Methods: Publications addressing health disparities and communication and procedural barriers to health care of transgender persons were identified by a structured search of electronic databases. The most pertinent articles are reviewed and consolidated with the authors' collective experiences. Results: To improve their interactions and communication with transgender persons, health care providers can take a variety of practical steps in several key areas: office environment, registration forms, initial interview and assessment, confidentiality, personnel training, awareness of and compliance with applicable antidiscrimination legislation, health insurance-related issues, and outreach and transgender health promotion. Conclusions: Enhancing patient satisfaction through culturally competent health care, quality assurance, and patient feedback is critical to creating open lines of communication between practitioner and patient and fostering a favorable context for transgender patient care.
Transgender identity and health care: Implications for psychosocial and physical evaluation
Journal of the American Academy of Nurse Practitioners, 2011
Purpose: The purpose of this article is to educate nurse practitioners (NPs) regarding: (a) the definition and range of transgenderism, (b) social influences on transgender persons, and (c) health care for transgender persons. Data sources: Data sources include review of the literature in the areas of gender, gender identity, marginalized populations, and gender transition. Personal communication was also utilized. Conclusions: Transgender persons remain marginalized and may remain closeted and at risk for negative psychosocial consequences. For those that do come out, other issues present, including the navigation of gender transition and psychosocial and physical changes that may be positive and/or negative. Examples of positive effects may include satisfaction of living authentically and decrease in depression. Negative effects may include social discrimination and loss of relationships. To provide holistic care, NPs need to be aware of transgender lives in social context and of their healthcare needs. Implications for practice: Suggestions for cultivating a supportive healthcare environment include the usage of sensitive language and an appropriate health history and physical examination. Further, to help rectify the knowledge deficit regarding transgender care among healthcare providers, NP educators and preceptors may utilize this article as a resource in their work with students.
Addressing Needs of Transgender Patients: The Role of Family Physicians
The Journal of the American Board of Family Medicine, 2020
There are approximately 1 million transgender and gender-diverse adults in the United States. Despite increased awareness and acceptance, they frequently encounter medical settings that are not welcoming and/or health care providers who are not knowledgeable about their health needs. Use of correct terminology, following best practices for name and pronoun use, and knowledge of gender-affirming interventions can create office environments that are welcoming to transgender clients. Health disparities faced by transgender patients that impact access to care include higher rates of mental health issues, substance use disorders, violence, and poverty. Transgender women are at greater risk for HIV acquisition and are less likely to achieve viral suppression compared with cisgender (nontransgender) individuals. Medical providers can facilitate HIV prevention efforts by offering pre-and postexposure prophylaxis to transgender patients at risk for HIV infection. Improving health outcomes requires attention to cultural competency and an understanding of lived experiences and priorities of transgender people.
Providing culturally sensitive care for transgender patients
Cognitive and Behavioral Practice, 2005
Culturally senszttve znformation is cruc*al for provzdzng approprzate care to any m,nonty populatzon Th2s art, cle provides an overview of *mportant issues to conszder when working w, th transgender patients, including clar~ficatzon of transgender termznology, dzagnoszs zssues, zdentity development, and approprzate pronoun use We also revzew common chnzcal zssues for transgender ind*vzduals seeking mental health care, how these can be addressed within a CBT framework, and the process of sett,ng up a CBT support group wzthin a VA hosp*tal system. CBT group outcome data and demonstratwe examples from male to female transsexuals are also presented.
BMC Health Services Research
Background Access to clinicians competent in transgender health remains a significant barrier and contributor toward health inequity for transgender people. Studies on access and barriers to care have predominantly evaluated transgender patients’ perceptions, but scant research has included the perspectives of clinicians. Aims We conducted a qualitative study to explore how clinicians (meaning physicians and advanced practice providers, in this paper) in the United States: (1) attain and utilize information, (2) perceive barriers and facilitators, and (3) understood gaps in their professional training, in regard to practicing transgender health care. Methods A Qualitative Descriptive approach guided our conventional content analysis of field notes and interviews with clinicians within a parent study that explored health care access among transgender adults. Transcripts were coded into meaning units that were iteratively abstracted into themes. Standard measures were performed to pro...
2016
The purpose of this project was to improve knowledge and identify personal bias and beliefs in the acute and primary healthcare needs of transgender persons, through the implementation of a clinical education program with healthcare providers and staff working within the urgent care and emergency department settings. The need for such a program exists due to the lack of suitable and accessible healthcare that may lead to misdiagnosis, delay of treatment and poor health outcomes. Including clinical education in the acute and primary healthcare needs of transgender persons that can be integrated into healthcare organizations may aid in the improvement of overall healthcare and healthcare experiences of transgender persons. Goals of the educational program included: increased healthcare provider and staff knowledge in the acute and primary care of transgender persons; identification of personal bias and beliefs in the healthcare of transgender persons; and the identification of factors...