Every day, transgender and gender-nonconforming people face relentless discrimination in employment, family life, housing, education, and public accommodation. But some of the most appalling discrimination occurs when these individuals reach out for help -- in health care settings. Barriers to care include negative experiences with health care personnel, lack of insurance, lack of transportation, provider ignorance, and the absence of institutional support for trans-affirming health care. The result is that transgender patients are among the most marginalized in our nation. The Gender Wellness Center (GWC) at Susquehanna Family Practice has been providing care for transgender patients in Oneonta, New York since 2007. Over time, we have developed a multidisciplinary treatment team and offer 1) trans-affirming primary care, 2) gender-affirming hormone therapy 3) on-site mental health services 4) a treatment program for gender nonconforming and transgender children and youth, and 5) a number of basic gender-affirming surgeries. We have served over 500 transgender patients from a wide geographic area and are currently seeing an exponential increase in the number of calls for our services.
Wicked Problem Description:
Although we are proud of our achievements, we are also aware that, as a center, we are loosely cobbled together. We lack training, personnel, appropriate information technology, a self-sustaining business model, institutional support and a cohesive strategic plan for moving forward. In 2014, New York’s Governor, Andrew Cuomo, mandated that all public and private insurance companies provide coverage for transition related health care. But only a few providers across the state are qualified to offer comprehensive transgender health services. As a result, patient need now exceeds our ability to provide quality care. We must expand, develop services to meet this growing demand and act as agents for change in our region.
The Gender Wellness Center proposes to create a Center of Excellence (COE) in Transgender Health at AO Fox Hospital/The Bassett Health Care Network. Our strategies and initiatives include providing medical, surgical, and mental health services, advocacy, research and training. We will be the leaders who can create an intentional and strategic plan to fulfill our mission and vision.
- Our mission is to provide comprehensive, affirming medical, surgical and mental health services for gender nonconforming people and their loved ones.
- Our vision is to serve as a regional center and to include comprehensive transgender health services, including medical, surgical and mental health, in a community based health care setting. We value evidence based, culturally competent care for pediatric and adult patients with diverse gender identities. We commit to community outreach, advocacy, community based research, and training for health care providers who are new to this field.
Our four scholars, with their diverse backgrounds in medicine, surgery and mental health, will build inter-professional teams to lead transformative change and create a culture of health based on health equity for gender diverse members of our community.
Current / Ongoing Strategies:
- Work with Bassett Research Institute to develop evaluation tools and plan for the project, develop and run focus groups for a needs assessment, create a logic model as a basis for a strategic plan, develop a patient registry and formulate research initiatives
- Identify and engage stakeholders within our network and the community we serve
- Identify new funding sources to build sustainability
- Seek funding to support staffing needs commensurate with growth in patient load
- Revise/ refine work flow and staffing pattern to coordinate, manage, and provide services available at our growing center.
- Develop a financially sustainable clinical practice model within our institution
- Hired consultant to facilitate strategic planning
- Established patient registry
- Identified stakeholders within our network
- Achieved the support of key stakeholders in the network
- Established dedicated fund for the Gender Wellness Center with the Friends of Bassett, the development division of our network
Anticipated Future Outcomes
- Complete 3-year strategic plan
- The GWC will become a model of multidisciplinary, well-coordinated, efficiently delivered affirming transgender healthcare.
- The GWC will become a sustainable entity within the Bassett Healthcare Network
- The GWC will be recognized as a regional Center of Excellence in Transgender Health
• Complete strategic planning process by 12/2017
• Operationalize plan 2018-2019
The GWC partners with The Institute for Gender, Relationships, Identity and Sexuality (TIGRIS) for training purposes, Choices Counseling and Consulting, Trillium Healthcare, Oneonta Pridefest, Susan Turell (PhD, clinical psych.), Patti Noon (LMSW), and the Friends of Bassett Foundation.
The Bassett Evaluation Studies Team (BEST) will evaluate the implementation of this grant by working closely with GWC staff and partners throughout the planning, implementation, and assessment stages to meet their information needs and feedback data soon after it is collected. Thus, the evaluation data are intended to be used to shape the evolution of the GWC on its road to a COE. Process indicators will include the number of meetings held for program development and implementation and whether action plans generated at these meetings result in measurable changes. The number and type of patients served, and the number of medical visits, mental health visits, pre or post-op surgical visits, surgeries completed will be monitored quarterly using EPIC beginning in year two. For quality of care assessment, a random sample of 10 charts will be drawn quarterly and reviewed by rotating member of the GWC staff to assess whether World Professional Association for Transgender Health (WPATH) standards are being met. The numbers of health care staff trainings offered on site, in community and academic settings will be tabulated annually. Training and mentoring of non-GWC health care providers, trainees, and community based non-healthcare providers with an interest in transgender health will be evaluated using pre- and post-training evaluation testing for knowledge and skill acquisition. The numbers of studies conducted, posters and abstracts presented and publications (and citations) will be measured to assess research productivity. Promotion of collaboration is and will be an important function of the GWC. Social Network Analysis (SNA) maps social networks in order to identify optimal routes for the spread of information.