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Transgender Health: Improving Care Through Collaboration J. Aleah Nesteby, RN, MSN, FNP Stephanie Huckel, Transgender Health: Improving Care Through Collaboration J. Aleah Nesteby, RN, MSN, FNP Stephanie Huckel, MS March 13, 2013

Building Bridges to Better Care Building Bridges to Better Care

‘Transgender’…? n n Most broadly defined as ‘transcending gender boundaries’ More frequently used to ‘Transgender’…? n n Most broadly defined as ‘transcending gender boundaries’ More frequently used to describe people whose gender identity and/or expression does not match the gender they were assigned at birth

Prevalance n In a telephone sample of MA residents, 131 out of 28, 045 Prevalance n In a telephone sample of MA residents, 131 out of 28, 045 respondents identified as transgender (0. 5% of population) (Conron, et al, 2012) n MA had 6, 587, 536 residents in 2011, which would mean a population of aprox 33, 000 transgender individuals in MA

A population at risk: n n n Violence Economic disadvantage HIV/AIDS Discrimination in healthcare A population at risk: n n n Violence Economic disadvantage HIV/AIDS Discrimination in healthcare Non-prescription/unsafe medications and procedures Depression/suicidality

Injustice at Every Turn: A Report of the National Transgender Discrimination Survey n n Injustice at Every Turn: A Report of the National Transgender Discrimination Survey n n 28% of survey participants reported “very high” levels of postponing medical care when sick or injured, due to discrimination 19% reported being refused care due to their transgender status or gender non-conforming status (higher numbers among POC) 28% reported being verbally harassed in a medical setting 50% reported having to teach their providers about transgender care

Principles of competent transgender health care n n n Respect the patient’s self-identification Use Principles of competent transgender health care n n n Respect the patient’s self-identification Use language that the patient prefers Insist upon respect from front desk, medical assistants, lab, non-clinical staff, etc. Work towards integration of trans-friendly language/options into EMR + forms Screening should be based on organ systems present Realistic risk assessment and harm reduction

How can clinical + administrative work together? How can clinical + administrative work together?

Collaboration n n Find allies across disciplines n Find “champions” 1: 1 discussions with Collaboration n n Find allies across disciplines n Find “champions” 1: 1 discussions with colleagues n Share personal stories/discuss local impact n Share journal articles/academic sources

Oh no…Roadblocks! Oh no…Roadblocks!

Problem: “We have so many other issues to work on, ” (Lack of resources) Problem: “We have so many other issues to work on, ” (Lack of resources) Solution: highlight importance of addressing trans access from a safety and diversity standpoint, suggest simple changes first Problem: “We don’t have transgender patients here, ” or “We don’t have any transgender employees. ” Solution: Share prevalence data, share needs assessment data (lit search), if possible share anecdotal evidence re: patients/employees Problem: Indifference Solution: Connect to agency mission statement, share personal stories

Creating buy-in, building trust n Organizationally n n n HRC Healthcare Equality Index Receiving Creating buy-in, building trust n Organizationally n n n HRC Healthcare Equality Index Receiving positive or negative feedback from clients Community-wide n n Informal or Formal community meetings Solicit feedback from transgender community n Needs assessments?

Common problems to address n n Resources for training n Clinical and non-clinical staff Common problems to address n n Resources for training n Clinical and non-clinical staff n Online vs. In-person trainings Bathrooms n Single-stall/unisex is preferred Insurance Questions n Inclusion/exclusion policies Referrals to specialists, testing n How to make sure the referred providers are transfriendly?

Positive results of improved transgender health care: n Benefits for patients: n n n Positive results of improved transgender health care: n Benefits for patients: n n n Improved quality of life (with transition care) Reduced suicide risk Lower rates of substance abuse Improved mental health outcomes Increased adherence to HIV treatment regimens Decreased morbidity with reduced avoidance of care

Positive results of improved transgender health care: n Benefits for employers: n n n Positive results of improved transgender health care: n Benefits for employers: n n n Helps to attract and maintain a diverse, talented workforce Increase employee comfort (and therefore productivity and loyalty) Eliminate hours wasted on time-intensive appeals and negotiation regarding reimbursement for health care services Positive word of mouth in community Provides opportunity for desired learning experiences among health care providers

Our experience: lessons learned n n n Most people aren’t hostile, just unfamiliar with Our experience: lessons learned n n n Most people aren’t hostile, just unfamiliar with the issues Power of positive/negative feedback from community and colleagues Support from middle and upper management is key n BUT you also need buy-in from direct care staff

Cooperation = Rainbows & Unicorns! Cooperation = Rainbows & Unicorns!

Questions? Questions?

J. Aleah Nesteby J. Aleah. Nesteby@baystatehealth. org 413 -794 -1316 Stephanie Huckel Stephanie. Huckel@BCBSRI. J. Aleah Nesteby J. Aleah. [email protected] org 413 -794 -1316 Stephanie Huckel Stephanie. [email protected] org 401 -459 -5008