The provider perspective on behavioral health care for transgender and gender nonconforming individuals in the Central Great Plains: A qualitative study of approaches and needs.

Abstract

Purpose-Transgender and gender nonconforming (TGNC) individuals interact with mental health care systems at high rates and experience substantial barriers to care. Rural TGNC individuals face additional disparities in accessing appropriate mental health services. Little research has focused on the mental healthcare providers who work with TGNC individuals in underserved areas. The current study sought to describe the mental health care services delivered by providers perceived as affirming by TGNC community members in the Central Great Plains.Methods-We conducted qualitative interviews with 10 providers to understand how providers seek cultural competency and conceptualize and work with their TGNC clients given the barriers to care.Results-Providers held diverse theoretical orientations and described challenges to working with TGNC clients including the impact of stigma and marginalization and financial and structural barriers to care. Emphasis was placed on individualizing care, helping clients manage stigma and build resiliency, connecting clients to resources (when available) and support systems, and navigating the intersections of physical health care and mental health care such as writing letters

Barriers to Accessing Health Care in Rural Regions by Transgender, Non-Binary, and Gender Diverse People: A Case-Based Scoping Review

“…Even in urban areas, a bottleneck situation exists due to the low number of trans-informed HCPs. The majority of trans people from one region seek treatment from the same few highly specialized experts, most of whom are known by name in the community and play an important gatekeeping role in health care, as highlighted in the European Trans Health Survey and qualitative individual interviews with 10 U.S. MHPs (mean age 56.4) about the health care situation ( 35 , 54 ).…”

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.

“…The Practice Adaptations focus mostly on common factors or more general aspects of psychological interventions to be most broadly applicable. A key strength of these Practice Adaptations is that they evolved from an iterative research process (Holt et al, 2020; Meyer et al, 2020) involving TGD community voices, community mental health clinicians, and academic scholars from a variety of disciplines.…”

“…Second, even when there are no mental health concerns, under current Standards of Care set by the World Professional Association for Transgender Heath (WPATH; Coleman et al, 2012), access to services for medical gender affirmation, including surgeries and hormones, may require a psychosocial assessment or mental health evaluation. Despite this high need, few mental health clinicians have received training for working with TGD clients and/or the training they received has been based on outdated models that pathologized TGD identities (e.g., Holt et al, 2020). Not surprisingly, when TGD people seek mental health care, they may be refused care or receive inadequate care (Holt et al, 2020; James et al, 2016).…”

“…Despite this high need, few mental health clinicians have received training for working with TGD clients and/or the training they received has been based on outdated models that pathologized TGD identities (e.g., Holt et al, 2020). Not surprisingly, when TGD people seek mental health care, they may be refused care or receive inadequate care (Holt et al, 2020; James et al, 2016).…”

“…From there, many potential clients seek online information and described scouring websites for signals a clinician may be competent and affirmative for TGD clients. Elsewhere, we have described ways clinicians can signal they are affirmative (Holt et al, 2020). The messages can be subtle if needed.…”