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Despite recent notable advances in societal equality for lesbian, gay, bisexual, and transgender (LGBT) individuals, youth who identify as trans* or gender nonconforming, in particular, continue to experience significant challenges accessing the services they need to grow into healthy adults. This policy perspective first offers background informat...
Context in source publication
Context 1
... do not know exactly how many people in the world are trans*, gender variant, or gender nonconforming, but data from the National Center for Transgender Equality suggest that the prevalence may be as high as 1% of the general population. 1,2 Not all children who are trans*, gen- der variant, or gender nonconforming will grow up to be transgender. This perspective uses the broader, more in- clusive umbrella term of gender nonconforming and all that this term includes, as shown in Figure ...
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The gender identity of trans individuals influences their treatment preferences, and this in turn seems to affect their individual treatment progress. However, there has been no research which—next to the impact of gender identity on treatment desires—has also investigated the influence of treatment progress using a measure which assumes various po...
Citations
... Gender has several dimensions, as shown by Dowshen et al. (2016) in their article on gender non-conforming children. There are different dimensions of gender and sex that need to be distinguished: ...
Journal: Umweltpsychologie!
The Gender Data Gap describes the problem of missing or unproportional representation of women in data sets. However, the Gender Data Gap goes beyond the pure composition of data sets. It also occurs when data do not contain the right information about the reality of women's lives in our society. Accordingly, to obtain realistic mobility data, such questions must be asked that reflect relevant aspects of women's mobility. By insufficient and biased representation of women, mobility data sets lack scientific quality, leading to biased assumptions and recommendations for future mobility. This article provides recommendations to avoid a Gender Data Gap in mobility by looking at empirical research in mobility. The relevance of gender and everyday mobility and an overview of the process of empirical research and its quality criteria are provided. The background of the Gender Data Gap in mobility is explained with five main gender biases in the field. Following the process of empirical research, recommendations are given using examples from the German Mobility Panel MiD 2017 and literature. These recommendations can be used to avoid a Gender Data Gap in mobility by showing how data can be systematically collected and used in a gender-sensitive way. The quality of mobility data can be improved by including women's perspectives on mobility.
... This was also true for transgender and gender-diverse (TGD) youth seeking access to gender-affirming care, which may include social or psychological supports and medical care that affirms an individual's gender identity. Telemedicine represented an important mode of care delivery for TGD youth, given that many experience substantial barriers to receiving gender-affirming care due to the limited number of clinics across the United States that deliver this care and the fact that few providers outside of these clinics have received formal training in this area [5][6][7]. However, few guidelines were in place for the provision of these services [3], and little research had been conducted regarding youth's needs and preferences with this modality of care delivery [8,9]. ...
... Such unique experiences illustrate the importance of understanding diverse patient perspectives as health care systems make decisions about whether and how to provide telemedicine services moving forward. As such, now that telemedicine services are more widespread, more research is needed to understand TGD youth's perspectives on receiving gender-affirming care via telemedicine and whether this could be a way to improve access and help overcome the unique barriers to care faced by this population [5,6,13]. ...
Background:
Access to virtual care has increased since the beginning of the COVID-19 pandemic, yet little is known about transgender and gender diverse (TGD) youth's experiences and perspectives on receiving care via telemedicine.
Objective:
The purpose of this study was to explore these experiences to 1) inform necessary changes to the provision of pediatric gender-affirming care and 2) help providers and health systems determine if and how telemedicine should be made available post-pandemic.
Methods:
Youth (14-17) who completed a telemedicine visit in the Seattle Children's Gender Clinic were invited to participate in a semi-structured interview exploring perceived advantages/disadvantages of telemedicine and preferred visit modalities. Interview transcriptions were analyzed by two research team members using an inductive thematic analysis framework.
Results:
Fifteen TGD youth completed an interview. Commonly cited advantages of telemedicine were convenience and comfort with having visits in their own environments. Reported disadvantages included technical issues, discomfort with the impersonal nature, lack of familiarity with the platform, and privacy concerns. Overall, slightly more youth preferred in-person visits over telemedicine, referencing both specific characteristics of the clinical visit (i.e., initial vs. return, complexity) and proximity to the clinic as reasons for this preference. Although a plurality of TGD youth preferred in-person visits, they also recognized the value of telemedicine and the impact it may have in facilitating access to care.
Conclusions:
Given variations in needs and visit complexity, our study supports the provision of both in-person and telemedicine modalities as options for pediatric gender-affirming care.
... orientation, for example, incorrectly use their pronoun and social name, have disrespectful attitudes, do not consider the patient's opinion, and decisions are made exclusively by the professionals themselves (Alpert, Cichoskikelly, & Fox, 2017;Costa et al., 2018;Dowshen et al., 2016;Müller, 2013). From the point of view of the LGBT+ public, when seeking health services, they perceive: unpreparedness of professionals to deal with the gay public; use of jokes and debauches; impact on the eyes; amazement at the practices among lesbians; discriminatory gynecological care; lack of professional training; lack of attention to the LGBT+ population, among others (Carvalho & Philippi, 2013). ...
This study aims to compare the mastery of competencies in assisting the LGBT+ population of Brazilian health professionals. Data collection occurred in a face-to-face and virtual manner, in the first semester of 2018. The health professionals answered a socio-demographic and functional questionnaire, in addition to the questionnaire Measurement of Training Needs for Health Care for the LGBT+ Public. The data was analyzed using Mann-Whitney and Chi-square tests. The project research was submitted to and approved by the IMED Research Ethics Committee (CAAE 69116917.6.0000.5319). The sample (n= 380) was made up mostly of psychologists (42.3%), female (81%), heterosexual (73.2%), aged between 26 and 35 years (36%), Catholic (41%), living in the south region (36.9%), and working in the profession for ten years or more (34.3%). Skills gaps on the LGBT+ theme was identified, especially in topics such as “approach to the patient’s sexuality,” “interference of religious beliefs in care,” “care with the genitalia and breast of the trans individual,” among others. Professionals trained in psychology and non-heterosexuals had a greater mastery of the theme than the others. The fragmentation of knowledge and skills hinders the full and equal access to the health system, and continued educational actions are recommended.
... [24][25][26][27][28] Unfortunately, many TGD youth do not receive appropriate care because of multiple barriers, including lack of accessible pediatric providers with sufficient knowledge about TGD people and genderaffirming health care, lack of protocols that are applied consistently, uncoordinated care, inadequate MH resources, insurance exclusions, and financial or socioeconomic limitations. [29][30][31][32][33][34][35][36] Additional barriers include state laws that promote discrimination and perpetuate health and health care disparities. [37][38][39][40][41] Parental/ guardian consent and difficulty navigating complex TGD youth policies and geographic barriers are additional obstacles to care. ...
OBJECTIVES:
Geographic barriers limit access to clinical care in the United States for transgender and gender-diverse (TGD) youth. Some factors differentiating access to care are variability in state laws/policies, the number of available clinical care programs and mental health providers for TGD youth.
METHODS:
We aggregated data from the Human Rights Campaign for pediatric clinical care programs for TGD youth, the Movement Advancement Project for state-by-state assessment of gender identity laws and policies, and Psychology Today for mental health providers for TGD youth by state. Current prevalence rates for TGD youth were applied by state with 2020 Census data. Findings were summarized as a whole and per capita by state, region, and country overall.
RESULTS:
The South has the highest number of TGD youth per clinic (36 465–186 377), and the lowest average equality score in gender identity laws and policies (1.96). The Midwest has the highest number of TGD youth per mental health provider (278–1422). The Northeast has the lowest number of TGD youth per clinic (11 094–56 703), the highest average equality score in laws and policies per state (17.75), and the highest average number of TGD youth per mental health providers (87–444).
CONCLUSIONS:
Findings support there are barriers to TGD youth care throughout the United States, especially the South and Midwest. Increasing medical and mental health care for TGD youth is likely to improve their health and well-being. Enacting gender identity protective laws/policies would allow for equal treatment and access to care among TGD youth.
... 4 The health care needs of transgender patients differ from those of cisgender patients. 5,6 Cisgender is a term used to describe an individual whose gender identity and/or gender expression aligns with the sex assigned to them at birth. 1,2 Some key aspects of transgender health care include hormone therapy, gender-affirmation surgeries, and interventions specific to mental and sexual health. ...
Context
Research suggests that athletic training students lack knowledge and experience providing care to transgender patients. Additionally, research has identified a lack of comfort with sexual health screening in peer health professions.
Objective
To assess how a curriculum, including a standardized patient (SP) encounter, influenced attitudes and skills in working with sexual health and gender minorities.
Design
Prospective observational study.
Setting
Simulation lab.
Patients or Other Participants
Twenty cisgender postbaccalaureate professional athletic training students (females = 16, males = 4; age = 23 ± 2 years).
Intervention(s)
The intervention included a focused curriculum on transgender health care and sexual health. In a culminating SP encounter, one group (n = 10) interacted with a cisgender woman and the second group (n = 10) with a transgender woman.
Main Outcome Measure(s)
The students completed a postintervention survey. Instruments included the Attitudes Towards Transgender Patients tool, which is divided into 3 subscales: clinician education, transgender sport participation, and clinician comfort; and the the Sexual Health Knowledge and Attitudes and Sexual History–Taking instruments, which evaluated the effectiveness of the sexual health curriculum on knowledge, attitudes, and comfort. The investigator and SP actor evaluated the SP encounters. Data were analyzed using descriptive statistics, nonparametric Mann-Whitney U, and 1-way analyses of variance.
Results
We identified a significant difference between those completing a transgender SP encounter (mean = 5.30 ± 2.11) and those completing the cisgender SP encounter (mean = 3.50 ± 0.97) on the clinician education subscale (P = .035). There were no differences between groups on the transgender sport participation (P = .70) and clinician comfort (P = .32) subscales. On the SP actor evaluation, we found no significant differences (P = .08).
Conclusions
The curriculum and SP encounter influenced knowledge, attitudes, and comfort when working with gender minorities and screening for sexual health.
... Hospitals should deliver patient-centered, intersectional, and culturally sensitive training to their staff that includes a wide range of topics that impact LGBTQ+ youth, such as health disparities, identity development, and the impact of bullying, discrimination, and victimization. Last, children's hospitals can implement various strategies to deliver ongoing trainings for students/ trainees and staff and continuing education opportunities for licensed providers (Dowshen et al., 2016). ...
This book provides an overview of risk and protective factors for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth and emerging adults to inform the clinical practice of mental health professionals who work with this population. Grounded in multicultural, intersectional, and positive youth development frameworks, this book emphasizes holistic health perspectives, integrated care approaches (of mental health with general health service delivery), and interdisciplinary team efforts targeting both the psychological and physical health needs of children, adolescents, and emerging adults. Mental health professionals and educators at any stage of their career who want to expand their knowledge base and improve their skill level for working effectively with LGBTQ+ children, adolescents, and emerging adults will find this a thought-provoking and illuminating resource.
... Given that the existing research suggests that access to gender-affirming care during adolescence is associated with improved mental health outcomes [3][4][5][6][7][8], increasing the availability of this care for TGD youths is critical. Currently, the provision of gender-affirming care is largely limited to specialty clinics located within pediatric hospital systems in large urban areas [9][10][11][12][13][14][15]. One way to improve the access and remove the barriers to gender-affirming care is by providing such care in the primary care setting. ...
Background
Access to gender-affirming care services for transgender and gender-diverse youths is limited, in part because this care is currently provided primarily by specialists. Telehealth platforms that enable primary care providers (PCPs) to receive education from and consult specialists may help improve the access to such services. However, little is known about PCPs’ preferences regarding receiving this support.
Objective
This study aimed to explore pediatric PCPs’ perspectives regarding optimal ways to provide telehealth-based support to facilitate gender-affirming care provision in the primary care setting.
Methods
PCPs who had previously requested support from the Seattle Children’s Gender Clinic were recruited to participate in semistructured, 1-hour web-based interviews. Overall, 3 specialist-to-PCP telehealth modalities (tele-education, electronic consultation, and telephonic consultation) were described, and the participants were invited to share their perspectives on the benefits and drawbacks of each modality, which modality would be the most effective, and the most important characteristics or outcomes of a successful platform. Interviews were transcribed and analyzed using a reflexive thematic analysis framework.
Results
The interviews were completed with 15 pediatric PCPs. The benefits of the tele-education platform were developing a network with other PCPs to facilitate shared learning, receiving comprehensive didactic and case-based education, having scheduled education sessions, and increasing provider confidence. The drawbacks were requiring a substantial time commitment and not allowing for real-time, patient-specific consultation. The benefits of the electronic consultation platform were convenient and efficient communication, documentation in the electronic health record, the ability to bill for provider time, and sufficient time to synthesize information. The drawbacks of this platform were electronic health record–related difficulties, text-based communication challenges, inability to receive an answer in real time, forced conversations with patients about billing, and limitations for providers who lack baseline knowledge. With respect to telephonic consultation, the benefits were having a dialogue with a specialist, receiving compensation for PCP’s time, and helping with high acuity or complex cases. The drawbacks were challenges associated with using the phone for communication, the limited expertise of the responding providers, and the lack of utility for nonemergent issues. Regarding the most effective platform, the responses were mixed, with 27% (4/15) preferring the electronic consultation, 27% (4/15) preferring tele-education, 20% (3/15) preferring telephonic consultation, and the remaining 27% (4/15) suggesting a hybrid of the 3 models.
Conclusions
A diverse suite of telehealth-based training and consultation services must be developed to meet the needs of PCPs with different levels of experience and training in gender-affirming care. Beyond the widely used telephonic consultation model, electronic consultation and tele-education may provide important alternative training and consultation opportunities to facilitate greater PCP independence and promote wider access to gender-affirming care.
... One population that often faces low satisfaction with health care providers due to disparities related to access and quality of care is patients who are gender minorities. 12,13 Gender is self-described and is a combination of a person's identity, expression, attributes, and how these components relate to traditional cultural norms and roles in society. 12,14 In the United States, societal norms typically divide gender into binary categories, male and female, that align with an individual's sex assigned at birth. ...
... 12,13 Gender is self-described and is a combination of a person's identity, expression, attributes, and how these components relate to traditional cultural norms and roles in society. 12,14 In the United States, societal norms typically divide gender into binary categories, male and female, that align with an individual's sex assigned at birth. However, sex assigned at birth and gender identity cannot be conflated. ...
... An individual's gender identity is a deeply rooted internal perception of self that may or may not align with their sex assigned at birth. 12,14 Gender expression is a term that describes a person's external presentation such as their behavior, clothing, hairstyle, or voice and may or may not be analogous to their identity. 14,15 These expressions may or may not correlate with societal expectations of masculinity and femininity or may be entirely androgynous. ...
Context
The United States transgender patient population often suffers from insufficient health care and faces barriers to obtaining health care. Understanding the current classroom education provided in professional athletic training programs related to patient-centered and transgender patient care is necessary to foster improvements to the education of future health care providers.
Objective
To explore the education, comfort, and experience of professional athletic training students and program directors (PDs) on patient-centered care (PCC) and transgender patient care.
Design
Cross-sectional survey.
Setting
Online survey.
Patients or Other Participants
A total of 74 PDs of Commission on Accreditation of Athletic Training Education-accredited professional athletic training programs (age = 46 ± 9 years) and 452 athletic training students (age = 23 ± 3 years) responded to the survey.
Data Collection and Analysis
Two surveys were created from literature and were reviewed by a committee of content experts. Participants were sent links to their respective survey in March 2020. Surveys contained questions on demographic information, PCC, and transgender patient care. Data were analyzed descriptively with follow-up χ2 analyses comparing athletic training students' comfort and competence between those who learned and did not learn about transgender patient care.
Results
Most PDs reportedly felt comfortable (98.6%, n = 73) and competent (94.6%, n = 70) teaching PCC. Half (50% n = 37/74) of PDs include transgender health care in their program's curriculum but lacked competence (37.8%, n = 28) in teaching. All students felt comfortable (100%, n = 452) and competent (98.7%, n = 446) practicing PCC, but only 12.4% (n = 54) reported practicing it during clinical education. Less than half (43.1%, n = 195/452) of students learned about transgender patient care, yet most (78.3%, n = 354) felt comfortable but lacked competence (41.8% n = 189).
Conclusions
Few students reportedly practice PCC during clinical education. Both groups perceived deficiencies in competence related to transgender patient care. We suggest PDs teach transgender health care in their curriculum and seek professional development to create meaningful educational experiences.
... A 2018 meta-analysis reveals that few studies have directly assessed medical student attitudes and knowledge about transgender patients and transgender health issues (Dubin et al., 2018). Of the few found, one 2016 study showed that 74% of medical students report receiving <2 hours of curricular time devoted to transgender clinical competency in all 4 years combined (Dowshen et al., 2016). A study at Boston University demonstrated that students reported lower knowledge and comfort with transgender and intersex health than lesbian, gay, and bisexual (LGB) health (Liang et al., 2017). ...
... [9][10][11][12] Unfortunately, few pediatric providers have the training and experience to support GDY, and those who do frequently practice in clinics affiliated with large urban academic medical centers. 13,14 This creates geographic barriers to receiving gender-affirming care as evidenced by our recent finding that > 30% of patients traveled > 1 h to receive care in one urban clinic. 15 Telemedicine, or clinical visits, which utilize twoway, real-time, synchronous, patient-to-clinician audiovideo technology, may address these geographic barriers to improve access to specialty care. ...
Purpose:
Telemedicine holds potential to improve access to gender-affirming care for gender-diverse youth (GDY), but little is known about youth's perspectives regarding its use. The purpose of this study was to explore GDY's experiences and satisfaction with telemedicine for gender-affirming care during the COVID-19 pandemic.
Methods:
An online, cross-sectional survey was completed by 12-17-year-old GDY after a telemedicine gender clinic visit. Demographic characteristics, responses to a 12-item telemedicine satisfaction scale, and items assessing interest in future telemedicine use were analyzed using descriptive statistics. Open-ended items exploring GDY's experiences were coded qualitatively to identify key themes.
Results:
Participants' (n=57) mean age was 15.6 years. A majority were satisfied with telemedicine (85%) and willing to use it in the future (88%). Most GDY preferred in-person visits for their first gender care visit (79%), with fewer preferring in-person for follow-up visits (47%). Three key themes emerged from the open-ended comments: (1) benefits of telemedicine including saving time and feeling safe; (2) usability of telemedicine such as privacy concerns and technological difficulties; and (3) telemedicine acceptability, which included comfort, impact on anxiety, camera use, and patient preference.
Conclusions:
Despite their preference for in-person visits, a majority of GDY were satisfied and comfortable with telemedicine, and expressed their interest in continuing to have telemedicine as an option for care. Pediatric gender care providers should continue services through telemedicine while implementing protocols related to privacy and hesitation regarding camera use. While adolescents may find telemedicine acceptable, it remains unclear whether telemedicine can improve access to gender-affirming care.
