Despite significant promise, the full impact of mental health technologies has yet to be realized. With overall mental health service utilization still below 50%, those with a disorder, racial/ethnic minority, low SES, and rural populations receive services at even lower rates. Mental health technologies have been designed and proposed to address the barriers exacerbating these disparities and low utilization. However, research on these tools, which to date has appropriately prioritized effectiveness, requires significant shifts to test the ways these tools may reduce disparities. This article reviews these tools and outlines a potential framework for research that can guide the translation of these technologies into data-driven dissemination and implementation strategies. K E Y W O R D Sdisparities, dissemination and implementation, mental health, review, technology 2 of 14 | RALSTON eT AL.

Background: Transgender and gender diverse (TGD) people encounter a range of minority stressors (e.g., harassment, victimization, misgendering) that impact many areas of life. Much of the empirical literature on gender minority stress has utilized frameworks that were developed with a focus on sexual orientation and were often limited to cisgender sexual minorities (lesbian, gay, bisexual, and other non-heterosexual individuals), leaving questions about how well existing models fit the experiences of TGD people. Aims: To expand understandings of gender minority stress, we conducted a daily diary study where participants detailed the types of stressors they encountered on a daily basis for 56 days. Methods: There were 181 TGD participants recruited into the study (M age = 25.6 years; SD = 5.6), with 167 retained in the daily surveys from which these analyses were conducted. Results:The written responses revealed a variety of stressors, some of which are novel to the literature. Many participants reported instances of non-affirmation, such as misgendering, as well as vicarious stress when learning of oppressive experiences impacting other TGD people and seeing negative media portrayals of the lives of TGD individuals. Participants also reported bodily vigilance when being on alert for how others were perceiving their gender. Other stressors included rejection, political oppression, physical violence, uneasiness from others, and the enforcement of gender binarism. Discussion: These findings highlight gaps in the existing understandings of marginalization for TGD people that must be addressed to ensure that frameworks include and center the experiences of gender minorities. Marginalization stressMinority stress theory was originally proposed to help explain the mental health disparities that

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There is a growing literature of clinical recommendations for transgender and gender diverse (TGD) affirming behavioral health care, yet it is unknown to what extent these recommendations are rooted in evidence-based practice (EBP). This systematic review included 65 articles published between 2009 and 2018 with recommendations for behavioral health services with TGD adults, emphasizing general clinical care. Coded variables included type of article, participant demographics, aspects of EBP, and whether care was informed by objective assessment. Most articles did not equally draw from all components of EBP. Recommendations for specific clinical problems are increasingly available and address diversity within TGD communities. More research, including clinical trials adapting established interventions, is needed to inform state-of-the-art TGD-affirmative behavioral health care. Public Health Significance StatementThis study highlights the need for improved guidance for affirming behavioral healthcare with transgender and gender diverse adults that integrates all aspects of evidence-based care: clinical judgment, research evidence, and patient characteristics.

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