Transforming the Landscape of Gender-Affirming Care for Transgender Youth Through Acute Rehabilitation Provider Empowerment

by Melissa Radlein

Coauthors: Priya Meyer, DNP, RN, PCNS-BC, NPD-BC

DEI Innovations

Transgender and gender diverse (TGD) individuals have higher risk of poor psychosocial outcomes, medical morbidities, and mortality. TGD individuals also experience significant barriers to accessing healthcare, some of note include transphobia, discrimination, refusal to provide care, and harassment. These barriers often stem from existing provider bias, lack of knowledge, and/or skills in the provision of transgender affirming care.
As demographic surveys have become more inclusive, the number of individuals identifying as TGD continues to grow. Healthcare providers are increasingly likely to serve patients who identify as TGD. Graduate-level clinical training and continued education have failed to keep up with the rapidly growing complex needs of this vulnerable population, resulting in a lack of foundational knowledge and self-efficacy among providers providing care today.
At one freestanding children’s hospital on the west coast, a pioneering gender-affirming (GA) surgical team serves at the cutting edge of evidence-based care for TGD youth. This team provides specialty surgical services for TGD youth as one in only six pediatric programs in the nation. This interprofessional GA team includes acute rehabilitation providers, who provide care at a pivotal moment in these patients’ gender affirmation journey and are thereby uniquely positioned to influence an affirming environment for this vulnerable population.
The purpose of this project is to increase acute rehabilitation provider knowledge and self-efficacy in the care of transgender and gender diverse (TGD) patients immediately following GA surgery. The secondary outcome of interest is level of provider bias.
The Johns Hopkins Evidence-Based Practice (EBP) model was used to synthesize evidence to produce best-practice recommendations for the care of TGD patients in the acute care environment. An evidence-based educational intervention is currently being designed with stakeholder input. The pilot program is due to launch in the acute rehabilitation department August 2023. A pre-post survey design using the LGBT-DOCSS will be used to determine effectiveness of the intervention. A two-tailed paired t-test will be used for analysis with an α set to 0.05.
Consistent, compelling research and clinical evidence supports transgender-specific cultural humility training for providers. Evaluation of this project will inform whether implementation of an innovative EBP educational initiative can improve knowledge, self-efficacy, and awareness of bias among acute rehabilitation providers caring for TGD youth. While foundation setting presents an essential starting point in improving patient outcomes and care quality for this growing population, the EBP process informing this project underscores a serious call to action for researchers to swiftly and rigorously address the paucity of research dedicated to the acute healthcare needs of TGD youth.