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