First impressions online: The inclusion of transgender and gender nonconforming identities and services in mental healthcare providers' online materials in the USA

Abstract

Background: When accessing mental healthcare services, transgender and gender nonconforming (TGNC) individuals face systemic barriers to gender-affirmative care. Initial points of contact, like intake forms, may show limited consideration for the heterogeneity of TGNC identities and can lead to negative consequences prior to face-to-face interaction with providers. Aims: The first aim was to mimic a likely pathway a TGNC individual may follow to seek mental healthcare services in the USA and to describe the extent to which they may encounter enacted stigma or affirmative messages that may impede or facilitate access to care. The second aim was to determine if a positive State legal climate for TGNC people was associated with more affirmative provider materials. Methods: Content analysis was used to examine a national sample of websites and intake forms of mental healthcare providers who advertise online as working with TGNC clients. Intake forms were coded for usage of affirmative language in gender/sex questions and including questions for a client’s pronouns and preferred name. Websites were coded for mentioning a variety of services or resources for TGNC clients. Results: While provider websites were found through Google searches for a “gender therapist,” only 56.6% of websites stated a provider specialty to work with TGNC clients and 32.1% of websites had no mention of services or resources for TGNC people. Additionally, a significantly larger proportion of intake forms from States with legal protections for TGNC people used affirmative language in gender/sex questions and asked for a client’s pronouns than intake forms from States without legal protections. Discussion: Barriers to affirmative healthcare for TGNC people within patient and provider interactions have been identified in previous research and these data show TGNC individuals may face enacted stigma even in their search for a provider, particularly those TGNC people living in States without legal protections.

Bridging the gap between practice guidelines and the therapy room: Community-derived practice adaptations for psychological services with transgender and gender diverse adults in the central United States.

“…Community participants in our interviews identified that markers of stigma and lack of support in the waiting room, paperwork, and initial encounters with a clinician or support staff often act as barriers to care or cause stress and anxiety. For example, a binary option for gender on intake paperwork conveys a stigmatizing message, whereas a blank space for specifying gender and the name you wish to be called allows maximum flexibility for a wide variety of gender identities and individual situations (Holt et al, 2019; Puckett et al, 2020). Another option is to defer discussion of these identity markers until in the privacy of the therapy room.…”

The impact of mental health care provider website transgender and nonbinary affirmation on site user experience for transgender/nonbinary and cisgender people.

“…Most research and recommendations have focused on how to provide affirming care to TGNB patients via patient–provider interactions, such as affirming pronoun use, affirming options on paperwork, and affirming clinical interviewing skills (American Psychological Association [APA], 2015; Hagen & Galupo, 2014; McPhail et al, 2016). Though some nascent work has addressed how affirmation of TGNB individuals begins even before the clinical encounter, when patients are seeking out providers (Holt et al, 2019). The aim of the current project was to extend UX research to UX of TGNB affirmation of mental health care provider webpages, focusing on the UX of websites from the perspectives of both TGNB and cisgender individuals.…”

“…The term transgender occurred on only 32% of the sites that had any LGBT-inclusive wording. In an analysis of websites for medical and behavioral health providers who were on the World Professional Association for Transgender Health provider finder page (Holt et al, 2019), a total of 527 websites were reviewed, along with 114 online intake forms for the providers. Trans-inclusive language was present in only 54% of intake forms; only 18% of intake forms provided a pronoun question and only 33% had a specific space for patients to enter a name different from their legal name.…”

“…Transgender and gender nonbinary (TGNB) individuals have historically faced enormous barriers in obtaining affirming care (James et al, 2016;Sperber et al, 2005) and within this community, interactions with providers have been a constant gamble in terms of risk for nonaffirming or discriminatory interactions (James et al, 2016;Mizock & Lundquist, 2016;Morris McPhail et al, 2016). Though some nascent work has addressed how affirmation of TGNB individuals begins even before the clinical encounter, when patients are seeking out providers (Holt et al, 2019). The aim of the current project was to extend UX research to UX of TGNB affirmation of mental health care provider webpages, focusing on the UX of websites from the perspectives of both TGNB and cisgender individuals.…”

Cisgenderism and transphobia in sexual health care and associations with testing for HIV and other sexually transmitted infections: Findings from the Australian Trans & Gender Diverse Sexual Health Survey

“…Access to health insurance is a known barrier, well documented in the United States [34] but also relevant in the Australian context, as a dearth of publicly funded options for medical gender affirmation diminish access among those without privately funded insurance coverage [35]. The intake paperwork, registration processes, and electronic medical record systems used by many health services often reproduce rigid categories of binary gender and confusion between patient gender, physical characteristics, and gender presumed at birth [36][37][38]. Many clinics fail to provide gender neutral bathrooms, which is a significant source of concern for many trans people [39] and part of broader organizational tensions that arise through gender segregation in health settings and an overall failure to spatially configure health spaces in ways that are affirming, confidential, and safe for trans patients [40,41].…”