Identify, Engage, Understand: Supporting Transgender Youth in an Inpatient Psychiatric Hospital

Barriers and facilitating strategies for healthcare access and reception for transgender children and adolescents

OBJECTIVES

to identify barriers and strategies that facilitate access and welcoming transgender children and adolescents in the Healthcare Network.

METHODS

an integrative literature review, with articles, available in full, with children and adolescents between 6 and 19 years of age, published between January 2013 and April 2023, in Portuguese, English or Spanish. The level of evidence was assessed using the JBI classification.

RESULTS

the main barriers were low professional knowledge, hostile professional interactions, and sexual presumption. Facilitating strategies included continuing education, questioning about gender and pronouns, and encouraging a respectful and welcoming environment.

CONCLUSIONS

this study indicates numerous barriers to access and support for transgender children and adolescents and strategies that can transform this context, aiming to move towards comprehensive care that recognizes, validates and supports gender identity with appropriate, safe and inclusive care.

The Use of Gender-Neutral Language in Psychiatric Care: A Qualitative Interview Study of Nurses' Perceptions and Experiences

Nurses in psychiatric and mental healthcare meet patients with varying backgrounds, including sexual and gender minorities. An essential part of nursing is the nurse-patient relationship, and previous research shows that LGBTQ patients desire a greater understanding of their needs, which can be illustrated in terms of a more inclusive linguistics usage, such as a gender-neutral language. There is, however, limited knowledge about nurses' views on this subject. The aim of this study was thus to describe nurses' perceptions and experiences on the use of gender-neutral language in psychiatric and mental healthcare. A qualitative, descriptive, and inductive approach was used, and 13 nurses working in psychiatric and mental healthcare were interviewed. The data were analysed with a qualitative content analysis, resulting in three themes; The nurses' understanding is characterised by individual prerequisites, The caring encounter is complex and requires normative awareness and responsibility, and The reflecting nurses become self-aware. The results are discussed and compared with the findings from previous research. The study also concludes that self-awareness and reflection play an important part in creating a safe environment for patients within the LGBTQ spectrum, where gender-neutral language can be used as an important tool for nursing in psychiatric and mental healthcare.

Gender-Affirming Mental Health Care for Transgender and Gender Diverse Youth on Pediatric Inpatient Psychiatry Units

Transgender and gender diverse (TGD) youth, individuals whose gender identity is different from the sex that was assigned at birth, report higher rates of mental health and emotional challenges and are approximately twice as likely to access psychiatric inpatient services compared with cisgender peers.1 Existing research has suggested that the minority stress that TGD youth face from having to navigate transphobic cultural contexts and systems (eg, unsupportive parents/caregivers, school staff, peers) may play a key factor in mental health disparities, such as increased risk of depression, anxiety, suicidal ideation, suicide attempts, and nonsuicidal self-harm.1,2 These higher rates of mental health challenges among TGD youth offer an explanation as to why these youth access inpatient services significantly more frequently than cisgender peers. Research has found that TGD youth often experience discrimination during psychiatric inpatient admissions (eg, being misgendered during admission intake, facing stigmatization for an evolving gender identity, and receiving care from staff who have not been trained to provide gender-affirming care),3 despite professional organizations, such as the American Academy of Child and Adolescent Psychiatry, underscoring the importance of TGD youth receiving psychiatric care that is inclusive and affirming.4 Given that the inpatient setting offers a unique opportunity to facilitate positive and affirming changes for TGD youth, it is essential for providers to have a strong understanding of what affirmative care looks like within this context to best support this vulnerable patient population and reduce experiences of discrimination.

Βarriers and Gaps to Medical Care for Transgender Individuals: A TRANSCARE Scoping Review with a Focus on Greece

Trans people face substantial barriers to care worldwide. In Greece, limited evidence regarding trans health and actions to improve accessibility in healthcare services is available. This study aims to identify barriers to care for transgender populations in order to discuss the potential gaps in healthcare providers' training in this direction. A scoping review was conducted in PubMed. Study eligibility criteria included: (a) reporting on at least one barrier to care for trans individuals or at least one educational need for healthcare providers; (b) free full text availability; and (c) publishing from 2015 and afterwards. Discrepancies in study inclusion were discussed between the research team until consensus was reached. Out of 560 identified references, 69 were included in this study, with only three reporting empirical research from Greece. Several individual-, interpersonal-, and institutional-level barriers to healthcare for trans individuals were identified. These included discriminatory treatment by healthcare providers, a lack of knowledgeable providers trained on trans-specific healthcare issues, lack of trusted and safe healthcare environments, health coverage-related issues, and healthcare systems that do not take into account particular transgender health issues during care provision. Improving access to care for transgender people is a multidimensional issue that should be addressed at the societal, healthcare, and research levels. Actions for future professional education initiatives should focus on respecting transgender identity, protecting confidentiality, creating trusted provider-patient relationships, and providing sufficient competency on trans-specific healthcare issues.

Affirming LGBTQIA+ Youth in Inpatient Psychiatric Settings

Decades of research show that LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and others) youth experience higher rates of psychiatric illness and present to mental health settings more often than their heterosexual, cisgender peers. General guidelines for working with LGBTQIA+ youth exist; however, little has been written about the unique challenges facing LGBTQIA+ youth and their families in inpatient psychiatric settings and strategies for ameliorating them. As LGBTQIA+ youth attempt suicide at much higher rates than their peers, inpatient settings see a disproportionate number of these youth. Providing LGBTQIA+ youth with affirming care during their inpatient admission therefore has the potential to shift mental illness trajectories of youth, increase family support, and reduce the number of lives lost to suicide. In this article, we outline specific barriers to affirming care in inpatient child and adolescent psychiatric settings and propose practical strategies that providers can implement to overcome these barriers.

Transgender and gender diverse youths' experiences of healthcare: A systematic review of qualitative studies

Transgender and gender-diverse (TGD) populations are identified as high-risk for negative healthcare outcomes. Limited data exists on experiences of TGD youths in healthcare. The review aim is to systematically review literature on healthcare experiences of TGD youths. Seven electronic databases were systematically searched for relevant studies. Pre-determined eligibility criteria were used for inclusion with a double-screening approach. Sixteen studies were included. Studies included were quality appraised, data were extracted, and findings were synthesized narratively. Four narratives were identified including experiences of: accessing care, healthcare settings and services, healthcare providers, and healthcare interventions. Long waiting times, lack of competent providers, and fear were reported as challenges to accessing gender-affirming care. Negative experiences occurred in mental health services and primary care, while school counseling and gender clinics were affirming. Puberty blockers and hormone-replacement therapy were identified as protective factors. TGD youths are at risk of negative health outcomes due to an under resourced healthcare system. Further research is needed to assess interventions implemented to improve TGD youth's experiences.

Functional Neurological Disorder Among Sexual and Gender Minority People

Sexual and gender minority (SGM) people can face unique stressors and structural discrimination that result in higher rates of neuropsychiatric symptoms, such as depression, anxiety, and suicidality. Although more rigorous studies are needed, emerging data suggest a possible higher prevalence of functional neurological disorder and other brain-mind-body conditions in SGM people. Representation and iterative feedback from affected community members is critical to the process of developing affirming environments. More research is needed to explore the relevance of functional neurologic disorder in SGM people within a biopsychosocial framework.

Assessment of Transgender/Gender-Expansive Accessibility in Inpatient Pediatric Mental Health Facilities

Purpose

This study surveyed a national sample of inpatient pediatric behavioral health facilities on policies related to care for transgender and gender-expansive (TGE) youth to assess adherence to best practices.

Methods

Staff/providers at youth inpatient psychiatric facilities were recruited by phone or email. Participants completed an electronic survey on facilities' training policies, staff comfort related to gender diversity, and other policies related to caring for TGE youth.

Results

Of 479 potential participating facilities, 124 surveys were initiated and 59 were completed. Measures to ensure accessibility to TGE patients are present in many facilities surveyed, with most reporting that their facility had nondiscrimination policies in place (86.2%) and required training on working with TGE patients (52.5%). A minority of participants (12.1%) reported that their facility roomed TGE youth based on sex assigned at birth, although only a small portion roomed based on gender identity alone (19.0%). Slightly more than two-thirds stated that their facility had individual restrooms available. Most participants (74.6%) stated that facility staff were comfortable discussing gender diversity in general, although this was less common for other topics related to TGE patient care.

Conclusion

Our survey highlights efforts made by inpatient behavioral health facilities to ensure accessibility of services to TGE youth, although our results showed notable differences across facilities. Given inconsistent federal protections for TGE patients, there remains a need for efforts to ensure that TGE youth are receiving all possible support in these treatment settings, such as accessible restrooms and bedroom assignments, as well as the opportunity to room with peers.

Transgender and Gender Diverse Youth in Inpatient and Other Residential Care

Inpatient and other residential care environments require special considerations for safety and unique opportunities to provide affirming care to TGD youth. Gender-positive policies, staff training, communication, placement, programming, and discharge planning are imperative; however, data and literature are limited in regard to affirming the care of TGD youth in such environments. This chapter draws from published research and best practice to support the wellness of TGD individuals in inpatient and similar settings. It offers clinical guidance for an organization's clinicians, administrators, educators, and advocates to provide safer and more effective care for TGD youth in such facilities to best support their mental and physical health.

Risk for Suicidal Behavior After Psychiatric Hospitalization Among Sexual and Gender Minority Patients

Importance

The months following inpatient psychiatric hospitalization are a period of high risk for suicidal behavior. Sexual and gender minority (SGM) individuals have elevated risk for suicidal behavior, but no prior research has examined whether SGM inpatients have disproportionate risk for suicidal behavior following discharge from psychiatric hospitalization.

Objectives

To evaluate whether SGM patients have elevated risk for suicidal behavior following discharge from psychiatric hospitalization compared with heterosexual and cisgender patients and to examine whether differences in risk across groups were accounted for by demographic characteristics and clinical factors known to be associated with suicidal behavior.

Design, Setting, and Participants

This prospective cohort study was conducted from August 2017 to July 2021 among inpatients aged 18 to 30 years who were voluntarily enrolled during psychiatric hospitalization. The study was conducted at an inpatient psychiatric hospital, with prospective data collected via follow-up visits and electronic health records.

Main Outcomes and Measures

Onset and/or recurrence of suicidal behavior following discharge from psychiatric hospitalization, assessed at follow-up visits and through electronic health records.

Results

A total of 160 patients were included, with 56 sexual minority (SM) and 15 gender minority (GM) patients. The median (IQR) age of the patients was 23.5 (20.4-27.6) years, 77 (48%) reported male sex assigned at birth, and 114 (71%) identified their race as White. During the follow-up period, 33 suicidal behavior events occurred (among 21% of patients). SM (hazard ratio [HR], 2.02; 95% CI, CI, 1.02-4.00; log-rank P = .04) and GM (HR, 4.27; 95% CI, 1.75-10.40; log-rank P < .001) patients had significantly higher risk for suicidal behavior compared with their heterosexual and cisgender counterparts, respectively, in bivariable analyses. Risk between SM and heterosexual patients was not different after controlling for demographic characteristics and clinical factors associated with suicidal behavior. GM patients exhibited elevated risk during the 100 days following discharge even after controlling for demographic and clinical characteristics (HR, 3.80; 95% CI, 1.18-11.19; P = .03).

Conclusions and Relevance

Within this cohort study of psychiatric patients, SGM patients had higher risk for suicidal behavior than non-SGM patients following discharge. While SM patients' risk was accounted for by clinical characteristics, GM patients' risk for suicidal behavior was not accounted for by their acute psychiatric state on admission. Future studies with larger subsamples of GM individuals are needed, and inpatient clinicians must attend to the unique needs of SGM individuals to ensure they receive affirming services.

Psychiatric Boarding of Transgender and Gender Diverse Youth Awaiting Treatment

With increased prevalence and duration of pediatric mental health boarding that disparately impacts transgender and gender diverse (TGD) youth, it is critical to consider disparities that TGD youth experience in accessing mental health care. Although mental health care for TGD youth has long been considered specialty care, frontline, primary medical, and mental health clinicians must be equipped to serve TGD patients' psychiatric needs. Inequities that TGD youth face require examination and intervention at multiple levels, including societal discrimination, lack of culturally responsive primary mental health care, and barriers to gender-affirming care in emergency departments and psychiatric inpatient units.

Attitudes and Beliefs of Mental Health Professionals towards Trans People: A Systematic Review of the Literature

A systematic review was conducted to assess and synthesize recent research on mental health professionals' attitudes towards trans people. The main objectives of our research were (a) to identify, synthesize, and analyze the scientific evidence available so far about the attitudes of mental health professionals towards the trans community, and (b) to determine the factors related to these professionals' attitudes, paying special attention to psychosocial and cultural aspects. A systematic search was carried out in the following electronic databases: Pubmed, Web of Science, PsycINFO, PsycARTICLES, Gender Studies Database, and Lilacs. A total of 32 articles of quantitative (n = 19), qualitative (n = 11), and mixed (n = 2) design, published up to March 2023, were included. Most studies used a cross-sectional or qualitative design, limiting the possibility of generalizing the results. The studies reviewed indicated mostly positive attitudes among the professionals, depending on their psychosocial characteristics. In line with the results of our review, we recommend that the training of professionals is important to improve their positive attitudes towards transgender and gender diverse people.

The role of social determinants of health in the receipt of school services after\\ traumatic brain injury: A focus review on underserved pediatric populations

BACKGROUND

Return to school is key for community re-integration after a traumatic brain injury (TBI). School support facilitates and ensure a successful transition back to school. However, access to school services is not uniform among U.S. children.

OBJECTIVE

To describe school services for children with TBI from minoritized backgrounds and highlight population-specific risk factors and facilitators for accessing services.

METHODS

Narrative review of the literature including studies on return to school after a mild-complicated, moderate, or severe TBI, among children enrolled in the U.S. school system. We describe receipt of services, enabling and risk factors, and outcomes, for minority children.

RESULTS

There is a gap in knowledge regarding return to school among minoritized children with TBIs. Studies have few participants from racial and ethnic minority backgrounds, or low income or rural communities. Transgender and non-binary youth are not represented in present research efforts. Studies highlight larger barriers to receipt of school services among minority children and additional barriers associated with their minority status.

CONCLUSION

Diversity in the U.S pediatric population is increasing. Minoritized populations are at increased risk for TBI and poor outcomes. Research focused on the needs of these populations is required to optimize school return after TBI hospitalization and overall post-discharge care.

Experiences of Transgender People Reviewing Their Electronic Health Records, a Qualitative Study

BACKGROUND

The 21st Century Cures Act and the OpenNotes movement have brought patients immediate access to their electronic health records (EHRs). The experiences of marginalized people, including transgender people, accessing and reviewing their EHRs could inform documentation guidelines to improve patient-clinician rapport and reduce harm.

OBJECTIVE

To investigate the experiences of transgender people reviewing EHRs.

DESIGN

Qualitative study using community-engaged research and an interpretive description methodology. Participants were recruited via social media, snowball sampling was employed, and purposive sampling was used to ensure diversity in terms of age, race/ethnicity, and other factors. In focus groups, participants were asked to discuss their experiences reviewing their EHRs and, for those participants who were clinicians, their experiences reviewing other clinicians' documentation.

PARTICIPANTS

Thirty transgender adults aged 20 to 67 years, including 10 clinicians.

APPROACH

Digital audio-recordings of focus groups were transcribed verbatim. Content was analyzed to identify emerging essential elements and analysis was continued until no new themes emerged (i.e., saturation).

KEY RESULTS

Four themes were noted. (1) Using the wrong name, pronoun, or gender marker for patients is common in the EHR, erodes trust, and causes trauma. (2) Various aspects of clinicians' notes contradict, blame, or stigmatize patients, across multiple axes of oppression. (3) Limitations of EHR capabilities create barriers to quality care. (4) Certain medical customs set the stage for marginalizing, objectifying, and pathologizing transgender people.

CONCLUSIONS

Transgender people experience harm via various aspects of EHR documentation, suggesting that changes must be made to improve patient-clinician relationships and reduce ill-effects for patients.

Sexual healthcare experiences of nonbinary young adults

Nonbinary young adults (who do not identify with a binary male or female identity and may hold diverse gender identities, including genderqueer, nonbinary and agender) may have unique and unmet sexual healthcare needs compared to binary transgender and cisgender people. However, there is limited knowledge about the sexual health and healthcare needs of nonbinary young adults. We conducted 19 semi-structured, in-depth interviews between August and November 2018 with nonbinary people aged 18-30 years in New England. Interview topics included experiences accessing sexual healthcare and engaging in sexual activity. Interviews were transcribed and transcripts were analysed using inductive and deductive thematic analysis. Three main themes were identified. First, participants described barriers to accessing high-quality sexual healthcare at both the interpersonal and institutional level. Second, participants employed strategies to meet their sexual healthcare needs despite encountering barriers. Third, participants articulated the ways nonbinary gender identities affect sexual relationships, with implications for sexual health. These findings underscore the need for research and advocacy - in collaboration with nonbinary persons themselves - to develop best practices to meet the sexual healthcare needs and advance the sexual health of nonbinary young people.

Gender and intersecting vulnerabilities on the mental health unit: Rethinking the dilemma

Background

Gender is routinely pitched as a key determinant of vulnerability for staff and residents on acute mental health inpatient units. Since the 1960's mixed gender units have become more prominent in Western health systems, yet questions remain around the configuration of these units, including how to ensure emotional and physical safety of those living and working in them.

Methods

This paper draws on a large study of the lived experiences of 42 staff and 43 service users from different acute mental health units in New Zealand. We conducted thematic analysis of interview data from four units with diverse architectural layouts to identify key themes central to decisions around gender and spatial design.

Results

Key themes emerged around gender-related trauma histories, safety perceptions and vulnerabilities, accommodation of gender-diverse and non-binary mental health service users, and gender-specific needs and differences. A further theme, of it goes beyond gender emphasized that there are many other non-gender attributes that influence vulnerability on the unit.

Conclusions

While findings emphasize the need for safe places for vulnerable people, trauma-informed care, access to staff who "understand," and recreation that is meaningful to the individual, we question if the dilemma of gender-separation vs. gender-mixing is an outmoded design consideration. Instead, we argue that a flexible, person-centered approach to provision of care, which values autonomy, privacy, and safety as defined by each service user, and that promotes choice-making, obviates a model where gender accommodations are fore. We found that a gender-exclusive narrative of vulnerability understates the role of other identifiers in dynamics of risk and vulnerability, including age, physicality, past violence, trauma history, mental unwellness, and substance use. We conclude gender need not be a central factor in decisions around design of prospective built unit environments or in occupational and clinical decisions. Instead, we suggest flexible spatial layouts that accommodate multiple vulnerabilities.

A Comparative Study on the Suitability and Treatment Compliance of an Improved Wristband Wearing Method Compared with the Traditional Method

Background

Wristband identification (wristband for short) is an accurate and reliable tool for patients, and it is the basic requirement of the whole medical activity of the hospital. Wearing wristband correctly can help clinical medical staff to identify patients quickly and accurately and effectively prevent medical errors and medical accidents. According to the survey, the wristband wearing rate of clinical patients is still low, mainly because the wristband is tight and improper and the medical staff education is not in place. Therefore, how to scientifically and effectively improve the wearing rate and accuracy of patients' wristbands is an urgent nursing safety problem to be solved. Accurate identification of children is the key to ensure the safety of clinical drug use and carry out diagnosis and treatment, and wearing wristbands is the main way to identify children.

Objective

A case-control study was conducted to explore the suitability and treatment compliance of an enhanced wristband wearing method compared with the traditional method.

Methods

260 hospitalized children admitted to our hospital from March 2019 to June 2021 were randomly divided into control group and study group. The control group used a traditional wristband, while the study group used a modified wristband. The existence of wristbands, the recognition speed of medical staff, the clarity of wristband handwriting, and the incidence of skin depression were observed in the two groups. The local skin reaction, wearing rate, incidence of wristband-related adverse events, identity compliance, and family satisfaction of patients with wristband were compared.

Results

In terms of authentication compliance, the normal authentication frequency of the observation group was higher than that of the control group, but the difference was not statistically significant (P > 0.05). The score of local skin reaction in the test group was lower than that in the control group, and the skin condition in the test group was better than that in the control group (P < 0.05). The incidence of adverse events in the observation group was significantly lower than that in the control group (P < 0.05). The proportion of wristband position, immediate recognition, and clear handwriting in the observation group was significantly higher than that in the control group in terms of wristband position, recognition speed, clear handwriting, and sunken skin (P < 0.05). There was no significant difference in the incidence of skin depression (P > 0.05). Parents' ratings of satisfaction with treatment and child wearing rates were compared. After the intervention, the parents' satisfaction with diagnosis and treatment in the observation group was 89.23%, which was significantly higher than that in the control group (79.23%) (P < 0.05). The score of wearing rate in the observation group was significantly higher than that in the control group (P < 0.05).

Conclusion

On the basis of ensuring children's compliance, the improved wristband wearing method can reduce the incidence of wristband shedding and ligature marks, reduce the diagnosis and treatment error rate, enhance the suitability of wearing, enhance the work efficiency of doctors and treaters, and improve the satisfaction of diagnosis and treatment.

Pediatric sexual orientation and gender identity data collection in the electronic health record

The systematic documentation of sexual orientation and gender identity data in electronic health records can improve patient-centered care and help to identify and address health disparities affecting sexual and gender minority populations. Although there are existing guidelines for sexual orientation and gender identity data among adult patients, there are not yet standard recommendations for pediatric patients. In this article, we discuss methods that pediatric primary care organizations can use to collect and document sexual orientation and gender identity information with children and adolescents in electronic health records. These recommendations take into consideration children's developmental stages, the role of caregivers, and the need to protect the privacy of this information. We also focus on the current limitations of electronic health records in capturing the nuances of sexual and gender minority identities and make suggestions for addressing these limitations.

Experiences and Perspectives of Transgender Youths in Accessing Health Care: A Systematic Review

Importance

Transgender and nonbinary youths have a higher incidence of a range of health conditions and may paradoxically face limited access to health care.

Objective

To describe the perspectives and needs of transgender youths in accessing health care.

Evidence Review

MEDLINE, Embase, PsycInfo, and the Cumulative Index to Nursing and Allied Health Literature were searched from inception to January 2021. Qualitative studies of transgender youths' perspectives on accessing health care were selected. Results from primary studies were extracted. Data were analyzed using thematic synthesis.

Findings

Ninety-one studies involving 884 participants aged 9 to 24 years across 17 countries were included. We identified 6 themes: experiencing pervasive stigma and discrimination in health care, feeling vulnerable and uncertain in decision-making, traversing risks to overcome systemic barriers to transitioning, internalizing intense fear of consequences, experiencing prejudice undermining help-seeking efforts, and experiencing strengthened gender identity and finding allies. Each theme encapsulated multiple subthemes.

Conclusions and Relevance

This review found that transgender youths contend with feelings of gender incongruence, fear, and vulnerability in accessing health care, which are compounded by legal, economic, and social barriers. This can lead to disengagement from care and resorting to high-risk and unsafe interventions. Improving access to gender-affirming care services with a cultural humility lens and addressing sociolegal stressors may improve outcomes in transgender and nonbinary youths.

Lesbian, Gay, Bisexual, Transgender, Queer Cultural Competency Training to Improve the Quality of Care: An Evidence-based Practice Project

BACKGROUND

One evidence-based practice strategy to improve the provision of care for the lesbian, gay, bisexual, transgender, queer population is providing cultural competency training. The aim of this evidence-based practice project was to improve Knowledge and Skills, Openness and Support, and Oppression Awareness for emergency nurses when providing care to the lesbian, gay, bisexual, transgender, queer population in the military health system.

METHODS

The single-unit, educational intervention posttest compared with unit personnel historical controls project took place in an emergency department within the military health system. The participants included registered nurses or licensed practical nurses working in the emergency department. The Ally Identity Measure tool was administered to an unmatched convenience sample of emergency nurses in a military health system pre- and postintervention to assess the intervention's effectiveness. Descriptive statistics and group difference testing (t test) were used.

RESULTS

The mean Knowledge and Skills subscale score was improved between the pre- and postintervention groups (t(70) = -3.33, P = .001). The mean Openness and Support subscale score was improved between the pre- and postintervention groups (t(70) = -2.06, P = .04). The mean Oppression Awareness subscale demonstrated no significant difference between the pre- and postintervention groups (t(70) = -0.93, P = .36).

CONCLUSION

This project illustrated the feasibility of an educational intervention to promote culturally competent care in the ED environment for the lesbian, gay, bisexual, transgender, queer population. The results illustrated that emergency nurses in this military health system were aware of the oppression that this vulnerable population faces.

'Treat me with respect': transgender persons' experiences of encounters with healthcare staff

BACKGROUND

Transgender persons face barriers to health care including discrimination and lack of awareness by professionals. This study aimed to describe transgender persons' experiences of encounters with healthcare staff.

METHODS

Participants were recruited through postings in social media and on websites targeting people identifying as transgender. Through an online form, 21 people identifying as transgender provided written self-reports. These were analysed using a method for inductive qualitative content analysis. The study was conducted in Sweden in 2018.

RESULTS

The results describe transgender persons' experiences and perceptions of encounters with healthcare staff in one theme: treat me with respect, and three main categories: accept me for who I am; treat me according to my needs; and meet me with competence.

CONCLUSIONS

Healthcare professionals can contribute in restoring and upholding transgender people's trust in health care by accepting their identity and focusing on their healthcare needs while also being informed about transgender people's needs and realities. A key point in this is recognising transgender person's vulnerability to violations of dignity in relation to health care.

A rapid review of gender, sex, and sexual orientation documentation in electronic health records

Objective

The lack of precise and inclusive gender, sex, and sexual orientation (GSSO) data in electronic health records (EHRs) is perpetuating inequities of sexual and gender minorities (SGM). We conducted a rapid review on how GSSO documentation in EHRs should be modernized to improve the health of SGM.

Materials and Methods

We searched MEDLINE from 2015 to 2020 with terms for gender, sex, sexual orientation, and electronic health/medical records. Only literature reviews, primary studies, and commentaries from peer-reviewed journals in English were included. Two researchers screened citations and reviewed articles with help from a third to reach consensus. Covidence, Excel, and Atlas-TI were used to track articles, extract data, and synthesize findings, respectively.

Results

Thirty-five articles were included. The 5 themes to modernize GSSO documentation in EHRs were (1) creating an inclusive, culturally competent environment with precise terminology and standardized data collection; (2) refining guidelines for identifying and matching SGM patients with their care needs; (3) improving patient-provider relationships by addressing patient rights and provider competencies; (4) recognizing techno-socio-organizational aspects when implementing GSSO in EHRs; and (5) addressing invisibility of SGM by expanding GSSO research.

Conclusions

The literature on GSSO documentation in EHRs is expanding. While this trend is encouraging, there are still knowledge gaps and practical challenges to enabling meaningful changes, such as organizational commitments to ensure affirming environments, and coordinated efforts to address technical, organizational, and social aspects of modernizing GSSO documentation. The adoption of an inclusive EHR to meet SGM needs is a journey that will evolve over time.

Hospitalization of Transgender Youth in a Psychiatric Ward—Opportunities and Challenges: A Case Study

The prevalence of children and adolescents who identify themselves as transgender is significant. Transgender youth are at a high risk for mental health problems, sometimes requiring hospitalization in a psychiatric ward. This situation is specifically complex and should be considered by all mental health professionals. In this case report, we describe the challenges that emerged during hospitalization of a transgender adolescent, followed by descriptions of our attempts to cope with these particular issues.

Adolescents with Gender Dysphoria: Reflections on Some Contemporary Clinical and Research Issues

This article provides an overview of five contemporary clinical and research issues pertaining to adolescents with a diagnosis of gender dysphoria: (1) increased referrals to specialized gender identity clinics; (2) alteration in the sex ratio; (3) suicidality; (4) "rapid-onset gender dysphoria" (ROGD) as a new developmental pathway; (5) and best practice clinical care for adolescents who may have ROGD.