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Talking, gawking, or getting it done: Provider trainings to increase cultural and clinical competence for transgender and gender-nonconforming patients and clients

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Abstract

This article presents a set of preliminary policy recommendations regarding competency trainings for health care providers to improve service delivery to transgender and gender-nonconforming clients. These recommendations are based in part on a program evaluation of trainings conducted in the northwestern United States in 2005–2006. Using a mixed-methods approach, the evaluation assessed the effectiveness of 3 competency trainings administered by a nonprofit health education and outreach organization serving lesbian, gay, bisexual, transgender, gender-nonconforming, and questioning people. Quantitative data indicated that the trainings were effective in transferring knowledge. Qualitative data confirmed this finding and elicited a number of themes about providers’ experience of the trainings and their posttraining questions about interacting with transgender and gender-nonconforming patients and clients. The authors propose policy recommendations to guide curriculum developers and trainers in developing content and structure and to facilitate implementation of lessons learned in trainings at an agency- or organization-wide level.

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References

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.

    Google Scholar 

  • Anderson, L. M., Scrimshaw S. C., Fullilove M. T., Fielding, J. E., Normand, J., & the Task Force on Community Preventive Services. (2003, April). Culturally competent healthcare systems: A systematic review. American Journal of Preventive Medicine, 24(Suppl. 1), 68–79.

    Article  PubMed  Google Scholar 

  • Association of American Medical Colleges. (2005). Tool for assessing cultural competence training (TACCT). Retrieved August 3, 2007, from http://www.aamc.org/meded/tacct/start.htm

  • Badgett, M. V. L., Lau, H., Sears, B., & Ho, D. (2007, June). Bias in the workplace: Consistent evidence of sexual orientation and gender identity discrimination. The Williams Institute, UCLA School of Law. Retrieved July 20, 2007, from http://www.law.ucla. edu/williamsinstitute/publications/Bias%20in% 20the% 20 Workplace.pdf

  • Beach, M. C., Price, E. G., Gary, T. L., Robinson, K. A., Gozu, A., Palacio, A., et al. (2005). Cultural competence: A systematic review of health care provider educational interventions. Medical Care, 43, 356–373.

    Article  PubMed  Google Scholar 

  • Beach, M. C., Saha, S., & Cooper, L. A. (2006, October 17). The role and relationship of cultural competence and patient-centeredness in health care quality [Electronic version]. New York: The Commonwealth Fund.

    Google Scholar 

  • Betancourt, J., Green, A., Carrillo, J., & Ananeh-Firempong, O. (2003). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118, 293–302.

    PubMed  Google Scholar 

  • Bhui, K., Warfa, N., Edonya, P., McKenzie, K., & Bhugra, D. (2007, January). Cultural competence in mental health care: A review of model evaluations. BMC Health Services Research, 7.

  • Bockting, W. O., Robinson, B. E., & Rosser, B. R. (1998). Transgender HIV prevention: A qualitative needs assessment. AIDS Care, 10, 505–525.

    Article  PubMed  Google Scholar 

  • Bonvicini, K. A., & Perlin, M. J. (2003, October). The same but different: Clinician-patient communication with gay and lesbian patients. Patient Education and Counseling, 51, 115–122.

    Article  PubMed  Google Scholar 

  • Boston Public Health Commission, LGBT Health. (2002). Double jeopardy : How racism and homophobia impact the health of Black and Latino lesbian, gay, bisexual, and transgender (LGBT) communities. Retrieved July 30, 2007, from http://www.lgbthealth. net/downloads/research/BPHCLGBTLatinoBlack HealthDispar.doc

  • Chrisman, N. J. (2007). Extending cultural competence through systems change: Academic, hospital, and community partnerships. Journal of Transcultural Nursing, 18, 68S-76S.

    Article  PubMed  Google Scholar 

  • Clements, K., Katz, M., & Marx, R. (1999, February 18). The Transgender Community Health Project: Descriptive results. San Francisco Department of Public Health. Retrieved August 6, 2007, from http://hivinsite.ucsf.edu/InSite.jsp?doc=2098.461e

  • Copeman, R. C. (1989). Medical students, aborigines and migrants: Evaluation of a teaching programme. The Medical Journal of Australia, 150, 84–87.

    PubMed  Google Scholar 

  • Corliss, H., Shankle, M., & Moyer, M. (2007, June). Research, curricula and resources related to lesbian, gay, bisexual, and transgender health in US schools of public health. American Journal of Public Health, 97, 1023–1027.

    Article  PubMed  Google Scholar 

  • Cross, T., Bazron, B. J., Dennis, K. W., & Isaacs, M. R. (1989). Towards a culturally competent system of care. Vol. 1: A monograph of effective services for minority children who are severely emotionally disturbed. Washington, DC: Georgetown University Child Development Center, National Technical Assistance Center for Children’s Mental Health.

    Google Scholar 

  • Culhane-Pera, K. A., Reif, C., Egli, E., Baker, N. J., & Kassekert, R. (1997). A curriculum for multicultural education in family medicine. Family Medicine, 29, 719–723.

    PubMed  Google Scholar 

  • Dean, L., Meyer, I. H., Robinson, K., Sell, R. L., Sember, R., Silenzio, V. M. B., et al. (2000). Lesbian, gay, bisexual, and transgender health: Findings and concerns. Journal of the Gay and Lesbian Medical Association, 4, 102–151.

    Article  Google Scholar 

  • Dogra, N., Giordano, J., & France, N. (2007). Cultural diversity teaching and issues of uncertainty: The findings of a qualitative study. BMC Medical Education, 7(8).

  • Feldman, J., & Bockting, W. (2003, July). Transgender health. Minnesota Medicine, 86, 25–33.

    PubMed  Google Scholar 

  • Feldman, J., & Goldberg, J. M. (2006). Transgender primary medical care: Suggested guidelines for clinicians in British Columbia. Vancouver, British Columbia, Canada: Vancouver Coastal Health Authority.

    Google Scholar 

  • Freire, P. (2000). Pedagogy of the oppressed. 30th anniversary edition. New York: Continuum.

    Google Scholar 

  • Gay and Lesbian Medical Association. (2001). Healthy People 2010: Companion document for gay, lesbian, bisexual, and transgender (LGBT) health. San Francisco: Author. Retrieved July 20, 2006, from http://www.glma.org/data/n0001/resources/live/ HealthyCompanionDoc3.pdf

    Google Scholar 

  • Goldberg, J. M., & Lindenberg D. (2006). Moving beyond trans-sensitivity: Developing clinical competence in transgender care (the Trans Care Project). Vancouver, British Columbia, Canada: Vancouver Coastal Health. Retrieved May 9, 2007, from http://www.vch.ca/transhealth/resources/library/tcpdocs/projectanalysis.pdf

    Google Scholar 

  • Hanssmann, C., Morrison, D., Russian, E., Shiu-Thornton, S., & Bowen, D. (2007). A program evaluation of community competency trainings. Manuscript submitted for publication.

  • Institute of Medicine. (2002). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press.

    Google Scholar 

  • Israel, G. E., & Tarver, D. (2003). Transgender care: Recommended guidelines, practical information, and personal accounts. Philadelphia: Temple University Press.

    Google Scholar 

  • Jones, C. P. (2000). Levels of racism: A theoretic framework and a gardener’s tale. American Journal of Public Health, 90, 1212–1215.

    Article  PubMed  Google Scholar 

  • Kenagy, G. (2005). Transgender health: Findings from two needs assessment studies in Philadelphia. Health & Social Work, 30, 19–26.

    Google Scholar 

  • Knowles, M. S. (1980). The modern practice of adult education. From pedagogy to andragogy (2nd ed.). Englewood Cliffs, NJ: Cambridge Adult Education.

    Google Scholar 

  • Lev, A. I. (2004). Transgender emergence: Therapeutic guidelines for working with gender-variant people and their families. Binghamton, NY: Haworth Clinical Practice Press.

    Google Scholar 

  • Lombardi, E. (2001). Enhancing transgender health care. American Journal of Public Health, 91, 869–872.

    Article  PubMed  Google Scholar 

  • Lurie, S. (2005). Identifying training needs of health care providers related to treatment and care of transgendered patients: A qualitative needs assessment conducted in New England. International Journal of Transgenderism, 8(2/3), 93–112.

    Article  Google Scholar 

  • Mansouri, M., & Lockyer, J. (2007). A meta-analysis of continuing medical education effectiveness. Journal of Continuing Education in the Health Professions, 27, 6–15.

    Article  PubMed  Google Scholar 

  • Marksamer, J., & Vade, D. (n.d.). Recommendations for transgender health care. Retrieved January 29, 2007, from Transgender Law Center website: http://www.transgenderlaw.org/resources/tlchealth.htm

  • Mason, J. (1995). Cultural Competence Self-Assessment Questionnaire: A manual for users. Portland, OR: Portland State University, Research and Training Center on Family Support and Children’s Mental Health.

    Google Scholar 

  • Mautner Project for Lesbians with Cancer. (2000). Providing culturally competent care to lesbians and women who partner with women. Washington, DC: Trainer’s Institute.

    Google Scholar 

  • Meyer, W., III, Bockting, W., Cohen-Kettenis, P., Coleman, E., DiCeglie, D., Devor, H., et al. (2001). The standards of care for gender identity disorders, sixth version. International Journal of Transgenderism, 5(1).

  • Minkler, M., & Wallerstein, N. (2003). Community based participatory research for health. San Francisco: Jossey-Bass.

    Google Scholar 

  • Minter, S., & Daley, C. (2003). Trans realities: A legal needs assessment of San Francisco’s transgender communities. San Francisco: National Center for Lesbian Rights, Transgender Law Center. Retrieved September 29, 2006, from http://www.nclrights.org/publications/transrealities0803.htm

    Google Scholar 

  • People of Color Against AIDS Network. (n.d.). Transgender time (T-time). Retrieved January 29, 2007, from http://www.pocaan.org/ttime.html

  • Pharr, S. (1988). Homophobia: A weapon of sexism. Inverness, CA: Chardon Press.

    Google Scholar 

  • Shapiro, J., Lie, D., Gutierrez, D., & Zhuang, G. (2006). “That never would have occurred to me”: A qualitative study of medical students’ views of a cultural competence curriculum. BMC Medical Education, 6(31).

  • Shiu-Thornton, S. (2003). Addressing cultural competency in research: Integrating a community-based participatory research approach. Alcoholism: Clinical and Experimental Research, 27, 1361–1364.

    Article  Google Scholar 

  • Spade, D. (2003). Resisting medicine, re/modeling gender. Berkeley Women’s Law Journal, 18, 15–37.

    Google Scholar 

  • Sperber, J., Landers, S., & Lawrence, S. (2005). Access to health care for transgendered persons: Results of a needs assessment in Boston. International Journal of Transgenderism, 8(2/3), 75–91.

    Article  Google Scholar 

  • Strauss, A., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park, CA: Sage.

    Google Scholar 

  • Taylor, J. (2003a, June). Confronting “culture” in medicine’s “culture of no culture.” Academic Medicine, 78, 555–559.

    Article  PubMed  Google Scholar 

  • Taylor, J. (2003b, June). The story catches you and you fall down: Tragedy, ethnography, and “cultural competence.” Medical Anthropology Quarterly, 17, 159–181.

    Article  PubMed  Google Scholar 

  • Tom Waddell Health Center. (2006). Revised protocols for hormonal reassignment of gender. San Francisco: Author.

    Google Scholar 

  • Xavier, J., Bobbin, M., Singer, B., & Budd, E. (2004). A needs assessment of transgendered people of color living in Washington, DC. International Journal of Transgenderism, 8(2/3), 31–47.

    Google Scholar 

  • Xavier, J., Hitchcock, D., Hollinshead, S., Keisling, M., Lewis, Y., Lombardi, E., et al. (2004, August). An overview of U.S. trans health priorities: A report by the Eliminating Disparities Working Group. Washington, DC: The National Coalition for LGBT Health.

    Google Scholar 

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Authors and Affiliations

  1. 2641 1/2 NW 64th Street, 98107, Seattle, WA

    Christoph Hanssmann

  2. 312 25thAve. S., 98144, Seattle, WA

    Darius Morrison

  3. Rehabilitation Department, University of Washington Medical Center, 1959 NE Pacific Street, Box 356490, 98195, Seattle, WA

    Ellery Russian

Authors
  1. Christoph Hanssmann
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  2. Darius Morrison
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  3. Ellery Russian
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Correspondence to Christoph Hanssmann.

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Hanssmann, C., Morrison, D. & Russian, E. Talking, gawking, or getting it done: Provider trainings to increase cultural and clinical competence for transgender and gender-nonconforming patients and clients. Sex Res Soc Policy 5, 5–23 (2008). https://doi.org/10.1525/srsp.2008.5.1.5

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