LGB/TGNB CULTURAL COMPETENCE IN HEALTH CARE - Finn Brigham, MS Director of Project - UofL Health
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LGB/TGNB CULTURAL COMPETENCE
IN HEALTH CARE
Finn Brigham, MS
Director of Project
Management
Who is this guy? ➢ Director of Project Management, former Director of Care Coordination ➢ Masters in Non-Profit Management ➢ Callen-Lorde employee for over 10 years ➢ Worked in LGBT health for 20 years ➢ Talked across the country about LGBT health including The White House ➢ Red Sox fan/Proud dog Dad ➢ Surfer (I didn’t say a good surfer) ➢ Real life trans person
Callen-Lorde Community
Health Center
Callen-Lorde Community Health Center provides sensitive, quality health care
and related services targeted to New York’s lesbian, gay, bisexual, and
transgender communities — in all their diversity — regardless of ability to
pay. To further this mission, Callen-Lorde promotes health education and
wellness, and advocates for LGBT health issues.
http://www.lambdalegal.org/sites/default/files/publications/downloads/whcic- insert_transgender-and-gender-nonconforming-people.pdf
Lambda Legal: When Health Care Isn’t Caring (2010)
http://www.lambdalegal.org/publications/when-health-care-isnt-caring
5
Increase in TGNB Care in the last 5 years
Unique Patients with Coded Encounters
5000
4607
4500
4188
4000 3983 4005 3977
3972
3863 3906 3923
3671 3732
3500 3508 3571
3319
3000
2800
2500
2226 HIV Coded
2120
2000 F64 Coded
1755
1500
1000
500
0
ACTIVITY Personal Comfort Assessment Tool – Individual Activity • Complete the assessment tool. • You will not have to share your answers with the group.
Agree Disagree Not Sure I am comfortable using the words “trans,” “transgender,” “gender non- conforming” I address transphobic behavior and/or language exhibited by colleagues I make an effort to use trans inclusive language in conversations I would be/am comfortable with transgender coworkers I would be/am comfortable about my child, or my relatives “coming out” to me as transgender I would be/am comfortable if a client comes out to me as transgender I use the name and pronoun clients/co-workers go by now, even if I know them previously under a different name or pronoun I advocate for leadership to review of my agency’s policies and procedures to ensure they are inclusive for transgender clients I would feel comfortable displaying an LGBTQIA+ Safe Space sticker or other visible signs of support I would be comfortable if someone thought I was transgender I am willing to put aside my personal beliefs to help a client make choices that work best for them
DEFINITIONS & TERMINOLOGY
SEXUAL ORIENTATION Sexual Orientation – The direction of one’s sexual or romantic attraction Lesbian- an identity label for women with primary sexual, romantic, relational ties to other women. Gay- an identity label for men who have primary sexual, romantic and relational ties to other men. Bisexual- an identity label for people who partner with either men or women. Asexual- an identity label for people without sexual feelings, associations, or desires. Queer - 1) An umbrella term sometimes used by LGBT people to refer to the entire LGBT community. 2) An alternative that some people use to "queer" the idea of the labels and categories such as lesbian, gay, bisexual etc. It is important to note that the word queer is an in-group term, and a word that can be considered offensive to some people, depending on their generation, geographic location, and relationship with the word. Pansexual - A person who experiences sexual, romantic, physical, and/or spiritual attraction for members of all gender identities/expressions, not just people who fit into the standard gender binary (i.e. men and women). Other terminology does exist and is culturally specific!
TRANS-RELATED TERMINOLOGY
• Transgender- A person who feels their sex assigned at
birth is a false or incomplete description of
themselves
• Transwoman/Transman- A person who was assigned
male at birth and lives and/or identifies as a woman/a
person who was assigned female at birth and lives
and/or identifies as a man
• Transsexual- A person whose gender identity is
inconsistent with their assigned sex, and desires to
permanently transition to the gender with which they
identify
• Genderqueer/Gender non conforming- A person who
does not identify with the gender/sex they were
assigned or with one of the binary genders (i.e. male
or female)TRANS-RELATED TERMINOLOGY • Sex assignment- The determination of an infant’s sex at birth • Cisgender/Cisman/Ciswoman- A person whose assigned sex is the same as their current gender identity; a non trans person • Hormone therapy/testosterone/estrogen- Hormones taken by a TGNC person to better align their gender identity with their physical body • Gender Affirming Surgery/SRS/bottom surgery/top surgery- Various surgeries a TGNC person may go through to further align their gender identity with their physical body
TRANS-RELATED TERMINOLOGY • Gender Marker- Refers to the M and F that are on many identity documents (license, passport etc) • Transphobia - The fear of trans people and the hatred, discrimination, intolerance, and prejudice that this fear brings
More on non-binary
Non binary is an identity while gender non
conforming is an action. You can be gender non
conforming but not necessarily be TGNB
Some binary TGNB people
have cisgender privilege.
Some trans people feel
“not trans enough”Words to Typically
Avoid 15
• Transgenders • Crossdresser
• A Transgender (noun) • Pre-Op
• Transgendering • Post-Op
• Transgendered • Hermaphrodite
• Tranny/Trannie • She-male
• Transvestite • He-She
• Transexual/Transsexual • It
Unless someone identifies themselves with that label and suggests
it’s appropriate for you to use it.Pronouns
16
• She Hers
• He His
• They Them
• Ze Hir
• Just my nameLGBTQ HISTORY
LGBTQ History • Prior to the 1960’s LGBTQI people were forced to live and love in the shadows • Same-sex activity and “cross-dressing” were illegal in many places • Homosexuality and “gender identity disorder” were listed as psychiatric disorders in the DSM, the primary diagnostic manual of mental health providers • Police raids, shakedowns, and arrests of LGBTQI people were everyday occurrences • On June 28, 1969, the Stonewall Inn was raided by NYPD officers – a common occurrence at what was known as a safe haven for the gay community. This time, patrons decided to fight back, protesting the violent treatment by police
IDENTITY
IDENTITY BUILDING BLOCKS
•Sex Assigned at Birth
•Gender identity
•Gender expression
•Sexual orientation
We all have these, and they may change over time.ACTIVITY
Trans does not
necessarily mean gay!
• TGNC does not necessarily equal gay/queer
• Some people are TGNC-identified and also LGBQ identified, some are
not
• For some TGNC people, having a straight identity is incredibly
important
• Gender variance is often understood in a queer context (LGBT), but
gender variance does not describe sexual orientation.
• For thought: Homophobic or “Anti-Gay” discrimination and
violence often target gender expression, not sexuality.Queerspawn
• Queerspawn
• An identity term used by youth and adults with one or more lesbian, gay,
bisexual, transgender, or queer parents/guardians. It is often used to
articulate one’s connection to queer community and claim a space in it.
• Culturally Queer
• Speaks to the feeling shared by many adults with LGBTQ parents that they
grew up immersed in queer culture, including traditions, celebrations,
media, and language. Queerspawn are often raised in the queer
community and learn about society primarily through a queer lens, and
experience heterosexual culture and its norms as a secondary cultural
influence.
• Issues- perfectionism, poster child syndrome, silencing- bullying/abuseLGBTQ-SPECIFIC HEALTH
CONCERNSHEALTH CONCERNS: SPECIFIC POPULATIONS
• WSW (women who have sex
with women)
• MSM (men who have sex with
men)
• Transgender patients (TGNC)
Health Issues relevant to ALL LGBT people: Alcohol/substance
use, tobacco use, depression and anxiety, lower levels of
insuranceHEALTH CONCERNS: WSW
• Fitness/obesity (diet and
exercise)
• Breast and cervical cancers
(higher rates for WSW)
• Alternative Insemination
• Barriers to preventative care
(insurance, fear/anxiety
around GYN care)
WSW: Women who have sex with womenHEALTH CONCERNS: MSM
• HIV and other STIs
• Prostate, testicular,
colon, and anal cancers
(anal paps)
• Hepatitis vaccination
• HPV vaccination
• PrEP
MSM: Men who have sex with menHEALTH CONCERNS: TRANSGENDER PATIENTS
• Access to care/Lack of
competent providers
• Hormone therapy
• Gender Affirming Surgery
• Complications from street
hormones and/or silicone
injections
• HIV and other STIs
• Fertility Concerns
Transgender: A person who feels their sex
assigned at birth is a false or incomplete
description of themselvesHEALTH CONCERNS: GENDERQUEER PATIENTS
• Genderqueer people exist and
need health care
• Some patients may want to be on a
low dose of hormones
• Some patients may want to go on
and off hormones
• Some patients may want surgery
but no hormones (or vice versa)
• Some genderqueer transmasculine
patients may want an IUD simply
to stop menstruating
Genderqueer: A person who does not identify
with the gender/sex they were assigned or with
one of the binary (i.e., male or female) gendersInformed Consent • Callen-Lorde uses an “informed consent” model to start hormones for patients. • In the past patients had to prove they were “living as their new gender” for X amount of time and were subject to approval from mental health providers. These rules were what were known as the Harvey Benjamin standards of care. • Callen-Lorde essentially says if a patient can consent to medical care, they can consent to hormones. • WPATH are the more widely used standards of care but are still not quite as liberal as Callen-Lorde’s standards.
Youth Puberty Blockers • These are medicine that block the release of hormones. This then stops testosterone from being released from the testes, and estrogen from being released from the ovaries. Without exposure to the sex hormones, the body does not undergo the changes associated with them • In transgender youth, puberty blockers are used to suppress the pubertal changes that quite often worsen the individual’s gender dysphoria. In addition, cross hormone therapy is even more effective at achieving the desired physical appearance in gender transition. • NY Medicaid WILL cover blockers
Intersectionality Having multiple oppressed identities (race, ethnicity, class, gender, sexual orientation, age, language, ability, etc.) affects physical and mental health, well- being, and health-seeking behaviors.
What is the Impact of Multiple Oppressions?
Intersectional Oppression Examples
• Race/Ethnicity: How will being targeted
by the police as a trans person of color
affect my safety?
• Class: How will I pay for transition-related
costs (freezing sperm, egg harvesting,
puberty blockers)?
• Ability: Will my provider doubt my
identity because of my bipolar disorder
diagnosis?
• Sex: Will I make less money after I
transition?Intersectional Oppression Examples • Orientation: Will I be subject to anti-gay bias? • Religion: Will I have to choose between gender affirmation and attending services at my religious institution? • Citizenship: Does my country of original allow me to change my identity documents? • Age: Will people believe me because I’m a child? • Age: Will I be able to find an affirming long-term care facility?
MICRO-AGGRESSIONS
Microaggressions & Privilege Goal • Understand the impact of subtle prejudice and discrimination that clients may experience commonly, or even daily, outside our clinics or agencies. Video: Janet Mock Flips the Script on Reporter https://www.youtube.com/watch?v=ISsdSvJhniQ&feature=yout u.be
Microaggressions
“Brief and commonplace daily, verbal, behavioral,
or environmental indignities, whether intentional
or unintentional, that communicate hostile,
derogatory, or negative slights and insults toward
members of oppressed groups" (Nadal, 2008, p.
23)
Intention ≠ ImpactSample Microaggressions
1. I never would’ve known you’re trans.
2. You’ll have to remind me to use the right pronoun because this is
hard for me.
3. I think you’re in the wrong bathroom.
4. I’ll always think of you as a [sex assigned at birth].
5. Tell me about your body, transition story, etc.
6. When are you having the surgery?
7. You’re so brave.
8. Have you seen that article about Caitlyn Jenner?
9. Where are you from?
10. You don’t talk like you are black
11. I don’t see color
12. How many children do you have (vs do you have children)
13. You are so articulateCREATING A WELCOMING
ENVIRONMENT AT YOUR
HEALTH CENTERCREATE A WELCOMING ENVIRONMENT • Have all-gender restrooms • Post or disseminate a non- discrimination policy which includes sexual orientation and gender identity/expression • Include LGBT information in brochures and educational materials • Openly display signs of LGBT acceptance (images, rainbow flag) • Acknowledge LGBT relevant days such as World AIDS Day and Transgender Day of Remembrance
CREATE A WELCOMING ENVIRONMENT • Have staff use their pronouns when introducing themselves to a group • Try not to use gendered terms such as “sir” or “ma'am” • Apologize if you make a mistake but then move on • If your agency does not provide hormones be sure you can refer to agency that does
LGBT Registration Form- Callen-Lorde
No marital status
question, but
“partnered” would be
an option if we had
one.
“We require the
following information for
the purposes of helping
our staff use the most
respectful language
when addressing you,
understanding our
population better, and
fulfilling our grant
reporting requirements.
The options for some of
these questions were
provided by our funders.
Please help us serve you
better by selecting the
best answers to these
questions. Thank You.”Hormone Protocols Online
Standards of Care
GLMA Provider Directory
44Putting it into practice • https://youtu.be/FS8jo34_gTg (Intake) • https://youtu.be/w5RPSBSiQPs (Shared space rooming) • https://youtu.be/-P1j_fASS9A (Shared space bathroom) • https://youtu.be/npEzyvu7urY (Billing)
Resources • Books- Redefining Realness Janet Mock, Trans Bodies Trans Selves, Stone Butch Blues and TransLiberation Leslie Feinberg, A Queer and Pleasant Danger Kate Bornstein • Movies/TV Shows- Pose, The Danish Girl, Transparent, Boys Don’t Cry, Paris is Burning, Her Story (web series) • National Geographic’s Gender Revolution with Katie Couric
Louisville Area Resources
i. Dr. Eli Pendleton at Baptist Health Deer Park Medical clinic.
https://www.baptisthealth.com/provider/michael-eli-pendleton-md-family-medicine
i. Dr. Kari Zahorik, who works at Norton Healthcare at the Midcity Plaza location:
https://providers.nortonhealthcare.com/provider/Kari+J+Zahorik/480996
ii. Dr. Clayton Smith at University of Louisville Hospital
https://www.uoflphysicians.com/1235371840-clayton-smith
i. Dr. Eddie Miller at University of Louisville Hospital https://uoflphysicians.com/provider/edward-miller/
ii. Dr. Susan Kingery – ULP/Norton Endocrinology Gender Clinic (specializes in youth)
https://providers.nortonhealthcare.com/provider/Suzanne+E+Kingery/482094
iii. Dr. Folsom Endocrinology - worked with Dr. Kingery and serves adults at Norton
https://providers.nortonhealthcare.com/provider/Lisal+J+Folsom/477127 .
Gender Affirming Surgery: Dr. Jon Witten at First Urology - https://1sturology.com/team/dr-jonathan-witten/
and plastic surgeon Dr. Tathyana Fensterer
https://www.aesthetics.com/our-plastic-surgery-practice-louisville/physicians-staff/surgical-team/tathyana-fensterer-
md/
Behavioral Healthcare:
1. Meridian Behavioral Healthcare takes all insurances and have a strong commitment to TGNB. They also provide
psychiatry. https://meridianbhservices.com/
2. Mandala House They have a Gender Process Group for different ages
https://mandalalouisville.com/Louisville Area Resource Continued
Supportive Organizations:
1. Kentucky Health Justice Network Trans Health Advocacy –Will
offer direct financial support for the cost of medical care,
housing, includes hormone care and safe injection materials,
binders,
etc. http://www.kentuckyhealthjusticenetwork.org/trans-
health.html
2. The Facebook Group Kentuckiana Transgender Support Group
3. The Louisville Youth Group: https://louisvilleyouthgroup.org/
4. Louisville Trans Men: https://louisvilletransmen.com/
5. Louisville Pride Foundation https://www.louisvillepride.com/
6. Queer Kentucky https://queerkentucky.com/
7. Transgender Wellness Summit Resource Guide
https://louisvilletws.com/resource-guide/Questions?
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