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 600 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. Our strategies and initiatives include providing advocacy, research, training, medical, surgical, and mental health services. 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

1. We are continuing to develop and operationalize our Strategic Plan. We hired a consultant to facilitate our strategic planning process and we have had 2 sessions with her, the 1st which spanned over 3 days in October 2017 and a follow-up retreat for a day and a half in January 2018. We have scheduled an additional follow-up retreat with her for the last weekend of September 2018.
2. We have identified stakeholders within our network and and have convened a Network Advisory Board to facilitate their ongoing engagement and support.
3. Work with BRI is ongoing and includes the use of our patient registry for research purposes as well as evaluation tools for our trainings and educational initiatives.
4. We are in the process of completing a Business Plan with the intent of communicating our value to the leadership of our Network and securing ongoing institutional support for the Gender Wellness Center.
5. We are in the process of working with our network marketing department and outside consultants to develop a dedicated website, logo and branding for the Gender Wellness Center.

Future Strategies

1. Develop a financially sustainable model within our network.
2. Establish a designated “place” for the Gender Wellness Center within our network.
3. Secure support for ongoing provision of mental health services within the Gender Wellness Center.

Outcomes:

1. Complete implementation of our 3-year strategic plan.
2. The GWC will become a model of multidisciplinary, well-coordinated, efficiently delivered affirming transgender health care.
3. The GWC will become a sustainable entity within the Bassett Healthcare Network.
4. The GWC will be recognized as a regional Center of Excellence in Transgender Health.

Completed Outcomes

1. Completion of a 3 year strategic plan.
2. Establishment of a patient registry.
3. Establishment of a dedicated fund for the GWC with the Friends of Bassett, the development division of our network.
4. Applied for and received a two-year grant from DSRIP to support an RN Coordinator for the GWC and hired RN for the position.

Timeline:

Operationalize strategic planning plan 2018-2019

Partnerships:

The GWC will partner with The Institute for Gender, Relationships, Identity and Sexuality (TIGRIS) for training purposes; Choices Counseling and Consulting; Oneonta Preidefest; Susan Turell (PhD, Clinical Psychologist), Patti Noon (LMSW), and Friends of Bassett Foundation.

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 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.