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Transgender Health: Improving Care Through Collaboration

Transgender Health: Improving Care Through Collaboration. J. Aleah Nesteby , RN, MSN, FNP Stephanie Huckel , MS March 13, 2013. Building Bridges to Better Care. ‘Transgender’…?. Most broadly defined as ‘transcending gender boundaries’

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Transgender Health: Improving Care Through Collaboration

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

  2. Building Bridges to Better Care

  3. ‘Transgender’…? • 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

  4. Prevalance • In a telephone sample of MA residents, 131 out of 28,045 respondents identified as transgender (0.5% of population) (Conron, et al, 2012) • MA had 6,587,536 residents in 2011, which would mean a population of aprox 33,000 transgender individuals in MA

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

  6. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey • 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

  7. Principles of competent transgender health care • 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

  8. How can clinical + administrative work together?

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

  10. Oh no…Roadblocks!

  11. 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

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

  13. Common problems to address • 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 trans-friendly?

  14. Positive results of improved transgender health care: • Benefits for patients: • 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

  15. Positive results of improved transgender health care: • Benefits for employers: • 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

  16. Our experience: lessons learned • 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 • BUT you also need buy-in from direct care staff

  17. Cooperation = Rainbows & Unicorns!

  18. Questions?

  19. J. Aleah Nesteby J.Aleah.Nesteby@baystatehealth.org 413-794-1316 Stephanie Huckel Stephanie.Huckel@BCBSRI.org 401-459-5008

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