Transcript Transgender Health: A Collaborative Approach

Transgender Health: Improving
Care Through Collaboration
J. Aleah Nesteby, RN, MSN, FNP
Stephanie Huckel, MS
March 13, 2013
Building Bridges to Better Care
‘Transgender’…?
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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
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In a telephone sample of MA residents,
131 out of 28,045 respondents identified
as transgender (0.5% of population) (Conron,
et al, 2012)
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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:
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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
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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
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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?
Collaboration
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Find allies across disciplines
 Find “champions”
1:1 discussions with colleagues
 Share personal stories/discuss local
impact
 Share journal articles/academic sources
Oh no…Roadblocks!
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
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Organizationally
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HRC Healthcare Equality Index
Receiving positive or negative feedback from
clients
Community-wide
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Informal or Formal community meetings
Solicit feedback from transgender community
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Needs assessments?
Common problems to address
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Resources for training
 Clinical and non-clinical staff
 Online vs. In-person trainings
Bathrooms
 Single-stall/unisex is preferred
Insurance Questions
 Inclusion/exclusion policies
Referrals to specialists, testing
 How to make sure the referred providers are transfriendly?
Positive results of improved
transgender health care:
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Benefits for patients:
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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:
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Benefits for employers:
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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
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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
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BUT you also need buy-in from direct care
staff
Cooperation = Rainbows & Unicorns!
Questions?
J. Aleah Nesteby
[email protected]
413-794-1316
Stephanie Huckel
[email protected]
401-459-5008