3D Transgender Health: Moving from Care to Caring

3D Transgender Health:
Moving from Care to Caring
Alfreda Rooks, MPA
March 20, 2015
Objectives
• Define the term “Transgender”
• Describe challenges transgender patients
experience with health care systems
• Identify strategies to improve the equity of
care for transgender patients
Framework
The acronym LGBT community is used to
describe a wide range of people of different,
races, ethnicities and age. Though, the use of
LGBT may indicate a unity of closeness we
expect to see in community; when it comes to
health care needs, the “T” often stands alone.
Framework
Experiences of transgender individuals seeking
health care and the challenges they face.
Caveat
There are many terms that may be used to
describe being gender non-conforming. The
terms used during this presentation are not
intended to be a complete representation of the
trans population.
Definitions
• Transgender
An umbrella to describe individuals whose
“idea” of gender is not consistent with one’s
birth sex.
Definitions
• Male-to-Female (MTF)
Used to describe a person born with male
genitalia but who identifies as female
Definitions
• Female-to-Male
Used to describe a person born with female
genitalia but who identifies as male
Definitions
• Gender Identity
A person’s internal sense of being a man, woman,
both or neither. Gender identity usually develops
at a young age.
Definitions
• Gender Expression/Role
The way a person acts, dresses, speaks and
behaves in order to show their gender as
feminine, masculine, both or neither
Definitions
• Gender Non-Conforming
People who express their gender differently than
what is culturally expected of them. A gender
non-conforming person is not necessarily
transgender (for example, a woman who dresses
in a masculine style but who identifies as female;
a boy who likes to play with dolls but identifies
himself as a boy, etc.)
Definitions
• Genderqueer
A relatively new term, genderqueer is used by
some individuals who do not identify as either
male or female, or identify as both male and
female.
Definitions
• Sexual Orientation
Sexual orientation is about how people identify
their physical and emotional attraction to others.
It is not related to gender identity.
Transgender people can be any sexual orientation
(gay, lesbian, bisexual, heterosexual/straight, no
label at all, or some other self-described label).
Definitions
• Terms to avoid
These terms are considered offensive by most and
should not used: she-male, he-she, it, tranny,
“real” woman or “real” man
Definitions
• World Professional Association for
Transgender Health, Inc.
The World Professional Association for
Transgender Health (WPATH) is an
international, multidisciplinary, professional
association whose mission is to promote
evidence-based care, education, research,
advocacy, public policy, and respect in
transsexual and transgender health.
Definitions
• World Professional Association for
Transgender Health, Inc. – Standards of Care
The vision of WPATH is a world wherein
transsexual, transgender, and gendernonconforming people benefit from access to
evidence-based health care, social services,
justice, and equality.
Changing Society
1950’s -
Changing Society
1970’s -
Changing Society
1990’s -
Changing Society
2000’s -
Changing Society
2010’s -
Challenges
“Transgender individuals face harassment,
discrimination, and rejection within our society.
Lack of awareness, knowledge, and sensitivity in
health care communities eventually leads to
inadequate access to, underutilization of, and
disparities within the health care system for this
population.” (ACOG, 2011)
Priority Issues for
Transgender Health
• Lack of insurance coverage for trans-specific
health services
• Lack of FDA approval for Transgender
Hormonal Therapy
• HIV/AIDS Prevention
• Immunization and Infectious Disease
Priority Issues for
Transgender Health
• Injury and Violence Prevention
• Suicide Prevention and Mental Health
Treatment
• Training in transgender-specific health care in
US Medical Schools
• Public Health Infrastructure
Priority Issues for
Transgender Health
• Sexually Transmitted Diseases
• Substance Abuse
• Tobacco Use
Challenges
Social determinants of health (SDOH) such as
socioeconomic status, education and
environment, play a significant role in the health
and well-being of transgender people and
should not be excluded from the healthcare
encounter.
Equity
Increasing equity for the transgender
community includes providing access to care,
reducing bias in service delivery and educating
providers on the unique needs of this
population.
Gender 101
When you provide care to a transgender client
or patient, respectful communication is
important to establish a level of trust and to
create a warm and accepting environment for
the person. The following recommendations
are intended to provide a foundation for your
interactions with your patient.
Gender 101
• Use inclusive language
• Be welcoming when patients discuss
relationships, sexuality and gender
• Provide a safe and affirming environment
• Do not make assumptions
Patient Rights
In August 2012, the Department of Human
Services announced that the Affordable Care
Act’s prohibition on sex-based discrimination
includes discrimination against transgender
persons based on how masculine or feminine a
person presents.
Patient Rights
Patients who experience discrimination at a
health care facility that accept Medicaid,
Medicare or other federal funding are able to
file a complaint for discrimination with Health
and Human Services.
Forms
1. What is your current gender identity? (Check
and/or circle ALL that apply)
○ Male
○ Female
○ Transgender Male/Trans Man/FTM
○ Transgender Female/Trans Woman/MTF
○ Genderqueer
○ Additional category (please specify): ___________
○ Decline to answer
2. What sex were you assigned at birth? (Check one)
○ Male
○ Female
○ Decline to answer
3. What pronouns do you prefer (e.g., he/him,
she/her)? ______________________________
Source: Understanding and Eliminating Disparities
Waiting Rooms/Bathrooms
• Prominently displayed Patient’s Bill of Rights
• Include “gender identity and gender
expression” in your or the institution’s NonDiscrimination Policy. Post policy where it can
be seen.
Waiting Rooms/Bathrooms
• LGBT appropriate reading literature.
• Have a single occupancy bathrooms that are
“gender neutral.” If this is not an option, have a
policy that allows transgender patients to use
the bathroom that matches their identity.
• Representative posters and artwork.
Culturally Appropriate Training
• Have annual culturally appropriate
training for all staff.
• Incorporate transgender educational
materials in New Employee Orientation
packets. One-on-one training within 30
days of employment.
CGSP
• Created in 1995
• Provide mental health, primary care, surgical
and ancillary services to the transgender
community
• 1,500+ patients
• Patients from 68 counties, 37 states and three
countries
Resources
• Advancing LGBT Health and Well-Being, US Department Health
and Human Services, Washington, DC (2014)
• Affirmative Care for Transgender and Non-Conforming People: Best
Practices for Front-line Health Care Staff, National LGBT Health
Center, Fenway Institute, Boston, MA (2012)
• Enhancing Cultural Competence: Welcoming, Lesbian, Gay,
Bisexual, Transgender, Queer People in Mental Health Services,
Planned Parenthood Mid-Hudson Valley Inc., Mental Health
Association of Ulster County, Inc., and the New York Association
for Gender Rights Advocacy (NYAGRA). (Unknown)
• HHS: Transgender Patients Protected From Discrimination,
Transgender Law Center. (transgenderlawcenter.org)
Resources
• Improving the Health Care of Lesbian, Gay, Bisexual and
Transgender People: Understanding and Eliminating Health
Disparities, Fenway Institute, Boston, MA (2012)
• The Affordable Care Act Helps LGBT Americans
(www.whitehouse.gov)
Thank you!
Alfreda Rooks
arooks@umich.edu
734-998-2156