Serving transgender people: clinical care considerations and service delivery models in transgender health

Carol,

Thank you for your response in regard to the importance of going beyond our call of duty as healthcare professionals to help transgender individuals integrate into the community more effectively and refute discrimination of all forms. According to a related article, “A recent report by the National Center for Transgender Equality and National Gay and Lesbian Task Force revealed that 63% of transgender people experience serious acts of discrimination that significantly impacts their quality of life” (Benson, K., 2013). This is a staggering statistic, and shows that this community of individuals needs our help in fighting this battle of discrimination and lack of access to health care.

Respectfully,
Colin McNeeley, OTAS

Reference:
Benson, K. E. (2013). Seeking support: Transgender client experiences with mental health services. Journal of Feminist Family Therapy. 17-40. doi: 10.1080/08952833.2013.755081

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Devlynn, good evening,

Thank you for your insightful discussion. I am interested in the various health concerns in those who identify as transgender. You stated, “They experience difficulties engaging in occupations due to various health experiences, diagnoses, and/or disorders.” I agree with you and found an upsetting health concern with suicide attempts.
Nearly 14% of adolescents reported a previous suicide attempt; disparities by gender
identity in suicide attempts were found. Female to male adolescents reported the highest
rate of attempted suicide (50.8%), followed by adolescents who identified as not exclusively
male or female (41.8%), male to female adolescents (29.9%), questioning adolescents
{27.9%), female adolescents (17.6%), and male adolescents (9.8%). (Toomey et al., 2018).

Our role as practitioners in suicide awareness and working with the survivors, and those at risk, along with family members, requires practitioners to be “aware of the contributing factors to suicide and be able to provide an appropriate response” (Novalis, 2017). Devlynn, can you share how you have implemented suicide awareness, or can you share ideas so that we can promote suicide awareness?
Occupational therapy practitioners have several tools to assess patients; furthermore, (Novalis, 2017) stated, “it is imperative that practitioners consider their therapeutic approaches and interventions, based at minimum, on models of practice, frames of references, and the Occupational Therapy Practice Framework.” The Framework can assist practitioners in constructing a clinical approach that supports the holistic views of our discipline. Devlynn, can you share any specific assessments that we could use to gather information about our patient’s interests?
As a practitioner, we can focus on our patient and their family’s awareness of signs and symptoms that mirror psychiatric conditions. We could also address the significance of medication management. According to (Novalis, 2017), “Contingency plans are particularly useful if the client can participate in creating the plan, as a means, in some sense, to self-direct appropriate action in the event of a relapse.” After further research, the Framework defines prevention as “education or health promotion efforts designed to identify, reduce, or prevent the onset and reduce the incidence of unhealthy conditions, risk factors, disease, or injuries” (AOTA, 2014, p. S44). Last semester I had a course called Theoretical Framework for Occupational Therapist and I learned so much information. After reading this research article and completing my research, I realized just how vital the Framework is to our discipline.
As practitioners working with these individuals, we must provide appropriate interventions that are meaningful to the patient, followed by assessing and implementing the patient’s interest. We could also use the therapeutic use of self-technique to engage our patients in the interventions. Implementing appropriate interventions, interests, and therapeutic use of self, we will facilitate an optimal experience and outcome for our patients.
I agree with you that our discipline has a pivotal role in suicide awareness, working with the
survivors, and those at risk, along with family members.
Respectfully,
Jade N. Clement, OTAS
References:
American Occupational Therapy Association. (2014). Occupational therapy practice.
Domain & process. Bethesda, MD
Suicide Awareness and Occupational Therapy for Suicide Survivors (n.d.). Retrieved
from https://www.aota.org/CE-Article-Novemember-pdf.

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Shelia,
I appreciate your thoughts on occupational therapy having the ability to create a safe place for people to explore new avenues of life or to simply be a resource for families to be as supportive as possible. Occupational therapists can work on modalities such as binding, tucking, and packing as stated in the thesis by Jamie Kimelstein. When an occupational therapist has knowledge on how to properly accomplish these tasks, the person who is seeking help within therapy can make them feel more comfortable and accepted by the people around them. Having the knowledge base is a step in the right direction to creating a safe place for people who do not feel accepted by their community. I was wondering if you had had any experience where certain information for people in the transgender community facilitated the creation of a safe environment?

Josephine, OTAS

Resource:
Kimelstein, J. (2019) Gender as anoccupation: The role of OT in the transgender community. Digital Commons. 15-20. doi: 10.16349/0261431.2138.0372341

Sheila,

I really like how you mentioned that OT can provide a safe place for transgender individuals to be themselves without judgement. According to the National Center for Transgender Equality, “More than one in four transgender people have lost a job due to bias, and more than three-fourths have experienced some form of workplace discrimination.” These are huge statistics. One way occupational therapists can help transgender individuals is by helping them find and maintain jobs by consulting on how individuals can become integrated and accustomed to their new roles.

Respectfully,
Anya Barg, OTAS

Retrieved from: https://transequality.org/issues/employment

@devlynn Thank you for your thoughtful and insightful response - those are great ideas! I appreciate your voice for those who are transgender (and generally LGBTQIA+) and I definitely think as faculty we can continue to do better to represent a diversity of patients in classroom discussions and in case studies. I really try to represent a variety of different gender expressions but hadn’t considered representing someone who is transgender in my client cases or patient examples (unfortunately). Thank you for bringing awareness to this important topic for OT students and practitioners.

Kindly,
Lauren

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I just want to add that transgender people facing discrimination and bias in the work setting is a systemic issue. If an individual trans person wants help in finding and maintaining employment then by all means they should have access to those resources. But most trans people individually cannot fix this issue. We most advocate for policy and cultural change to ensure that our work places are safe and welcoming for transgender people.

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Thank you for sharing this information.
It’s very much essential to sensitize therapists as well as others in society towards the health of transgenders.
I recently attended a seminar on concerns of LGBTQ community as part of a research study…The seminar was an eye opener and it definitely identified the need to educate masses in India over this issue.
Thanks again for bringing up such novel and diverse concerns on the club.
Regards,
Preetee

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Very good research article. Great takeaways

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Impressed to know you worked with this population. In my long career, I never did

Lots of good information. Thanks much

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