TRANSforming Health Care: Making Our Center More Inclusive For Transgender Patients

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TRANSforming Health Care Making Our Center
More Inclusive For Transgender Patients

• Erika Patterson, Ph.D.
• Stephanie Bagby-Stone, M.D.
• David Tager, Ph.D.
• Heather Eastman-Mueller, Ph.D.

Susan Even, M.D. Deneal Sullivan,
R.N., M.P.A. Ann Nadler, M.A. Scott Henderson,
M.D.
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What is Trans?

• We utilize trans as an umbrella term for people
  who transgress or transcend our normative notions
  of gender. This term includes but is not limited
  to those who identify as transgender,
  transsexual, bigender, gender queer, gender
  fluid, two spirit, cross dressers, or gender
  benders.

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Overview

• Transforming Our Center Initiative
• What is Gender Identity? The Story of K
• Health Disparities Scope of Problem
• Transforming Our Center
• Hormone Replacement Therapy/Insurance
• Questions and Discussion

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Understanding Terminology I

• Gender (culture) social construction of
  masculinity and femininity varies by culture and
  time
• Sex (body) biological classification of people
  based on biological or medical characteristics
• Sexual Orientation (heart) who we love, are
  attracted to, or attach to sexually and/or
  emotionally, desire

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Understanding Terminology II

• Gender Identity (mind) internal sense of
  masculinity and femininity not necessarily
  visible
• Gender Expression (appearance) how we present
  ourselves as men and womenor somewhere in
  between or outside of normative trends, or with
  no gender, includes clothing, hairstyle, voice,
  mannerisms

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The Catalyst for Change

• The Story of K (2006-2011)
• Helping us to understand and respond

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Health Disparities

• National Transgender Discrimination Survey (NTDS
  2010), surveyed over 7,000 trans-identified and
  gender non-conforming individuals
• 19 reported being refused health care
• 28 reported being discriminated against in
  medical settings
• 50 reported having to teach healthcare providers
  about their healthcare needs

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Health Disparities II

• The need for healthcare tends to be great in the
  transgender population due to high levels of
  societal discrimination, stigma and the trauma of
  rejection (Herek, 2007 Lev, 2004)
• PTSD in gender non-conforming population almost
  2x higher (Roberts, et al., 2012)
• 41 of trans-identified individuals surveyed
  (2010) reported at least one suicide attempt
• Yet only 28 of psychologists feel sufficiently
  familiar with transgender issues (Schneider,
  2008)

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Transforming Our Center

• Gender neutral bathroom
• Train staffall roles
• Paperwork/signage for trans-inclusivity
• Check In Procedure
• Implement Hormone Replacement Therapy (HRT)
• Advocate for insurance coverage
• Provide more culturally effective and integrated
  care for trans-identified students

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Traditional Version
Inclusive Version
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Insurance Coverage

• UM system wide coverage
• medically necessary treatment
• AMA supports public and private health insurance
  coverage for treatment of gender identity
  disorder as recommended by the patients
  physician. (AMA Ethical Guideline H-185.950)

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I wondered why somebody didn't do something.
Then I realized, I am somebody. - Unknown
Author
Dr. Even Kate Bornstein, Gender Activist
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Transition-Related Medical Care

• Transition-Related Care increases Overall Care
• Physician Basic Skills Competencies HRT 101
• Specific Challenges and the Learning Curve
• Networking with other physicians
• First Patients Successes

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HRT Quick Reference
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Thank You!

• For more information contact
• Susan Even, M.D. evens_at_health.missouri.edu
• Scott Henderson, M.D., hendersons_at_health.missouri.
  edu