A Center of Excellence in Transgender Health for Upstate New York

Background:

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
5. A number of basic gender-affirming surgeries

We have served over 300 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.

Project Strategies:

The Gender Wellness Center proposes to create a Center of Excellence (COE) in Transgender Health at AO Fox Hospital/The Bassett Health Care Network with the support of the Clinical Scholars initiative. This initiative will provide us the resources to become 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 five scholars, with their diverse backgrounds in medicine, surgery and mental health, will build interprofessional teams to lead transformative change and create a culture of health based on health equity for gender diverse members of our community.

Our approach

1. The GWC will form an exploratory committee made up of our clinical scholars and appropriate associated personnel to determine the feasibility of a COE for Transgender Health within the Fox/Bassett Health Care Network. This committee will conduct a gap analysis, solicit input from care providers in our region, as well as a community board of transgender people and their families, and perform a needs assessment;
2. The GWC will develop a Strategic Plan, including a timeline and resources for creating the COE.
3. The GWC will present our findings and proposal to the Fox/Bassett leadership for further consideration.
4. The GWC will implement its plan.

Outcomes:

1. A completed GAP analysis for services currently offered through the Gender Wellness Center;
2. A report from meetings convened with a community advisory committee of transgender people and their families to solicit input about health care needs in our region;
3. A completed needs assessment for a COE in Transgender Health, with attention to known health care disparities and barriers to care for our regional population;
4. A completed strategic plan for the creation of a COE in Transgender Health, that includes:
   1. comprehensive medical
   2. mental health
   3. surgical services
   4. training
   5. research opportunities
   6. advocacy
5. The final plan will include measurable goals and evidence-based quality indicators
6. Annual reports on the implementation of the strategic plan;
7. Annual reports on patient care through the COE based on evaluation measures defined below.

Partnerships:

The GWC will partner with The Institute for Gender, Relationships, Identity and Sexuality (TIGRIS) for training purposes, and with Susan Turell, PhD, clinical psychologist for development of an integrated mental health program.

Evaluation Strategies:

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. 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 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.