Determine the (a) training, experience, and attitudes and (b) current practices and self-reported competence of a nationwide sample of Veterans Health Administration clinical psychologists; and (c) whether these vary by region and age. An anonymous online survey was distributed via email link to 2,294 Veterans Administration psychologists that had 52 quantitative questions (categories: demographic, training, experience, current practice, self-reported competence, attitudes/knowledge, and need/interest for training) and yielded 384 respondents. We separated participants into younger and older groups as well as regional groups (more progressive vs. more conservative). Analyses were descriptive, correlational, and tests of mean differences. Overall, psychologists had minimal training in areas of sexual orientation and gender identity and limited experience delivering services to these populations. As a group, older psychologists had less graduate training in issues of sexual orientation and gender identity. Younger psychologists had more LGBT-affirmative attitudes, though less lifetime training. Progressive regions had more LGBT-affirmative attitudes, more sexual orientation training, and were more interested in further training. Training in areas of sexual orientation and gender identity during graduate school correlated significantly with later practice. Self-rated competence was not aligned with levels of training and experience. Additional training is indicated and should be tailored to regional needs. Graduate school/internship may be a training opportunity that has a lifetime practice impact. More research is needed to understand the relationship of self-rated competence to training and experience and how to better align these variables.

Psychologists are integral to the care of transgender individuals. This article details the many roles for psychologists in transgender-specific care, including diagnosing and treating gender dysphoria; providing treatment for comorbid conditions; referring to medical services such as gender confirmation surgeries, voice modification, and cross-sex hormone therapies; serving as consultants within health care systems; and advocating for addressing barriers in systems in which transgender individuals live and work. Transgender veterans have unique experiences and vulnerabilities related to their military service that are detailed from a review of the literature, and we make the case that Veterans Health Administration (VHA) and community psychologists are well-positioned to provide care to transgender veterans (trans-vets). In this article, the authors describe the experiences that many trans-vets have faced, identify the importance of treatment for gender dysphoria (and draw the distinction between gender identity disorder and gender dysphoria) as well as psychologists' roles, and clarify which transgender-related services are available to eligible veterans though VHA per policy and how VHA providers have access to training to provide that care. In addition, we describe how veterans can connect to the VHA, even if they have (and want to continue working with) non-VHA psychologists or other community providers.

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Purpose: The Veteran's Health Administration (VHA) has created a training program for interdisciplinary teams of providers on the unique treatment needs of transgender veterans. An overview of this program's structure and content is described along with an evaluation of each session and the program overall.Methods: A specialty care team delivered 14 didactic courses supplemented with case consultation twice per month over the course of 7 months through video teleconferencing to 16 teams of learners. Each team, consisting of at least one mental health provider (e.g., social worker, psychologist, or psychiatrist) and one medical provider (e.g., physician, nurse, physician assistant, advanced practice nurse, or pharmacist), received training and consultation on transgender veteran care.Results: In the first three waves of learners, 111 providers across a variety of disciplines attended the sessions and received training. Didactic topics included hormone therapy initiation and adjustments, primary care issues, advocacy within the system, and psychotherapy issues. Responses were provided to 39 veteran-specific consult questions to augment learning. Learners reported an increase in knowledge plus an increase in team cohesion and functioning. As a result, learners anticipated treating more transgender veterans in the future.Conclusion: VHA providers are learning about the unique healthcare needs of transgender veterans and benefitting from the training opportunity offered through the Transgender Specialty Care Access Network–Extension of Community Healthcare Outcomes program. The success of this program in training interdisciplinary teams of providers suggests that it might serve as a model for other large healthcare systems. In addition, it provides a path forward for individual learners (both within VHA and in the community) who wish to increase their knowledge.

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