Transgender Veterans and the Veterans Health Administration: Exploring the Experiences of Transgender Veterans in the Veterans Affairs Healthcare System

Rosentel, Kris; Hill, Brian H.; Lu, Connie; Barnett, Joshua Trey

doi:10.1089/trgh.2016.0006

Cited by 34 publications

(24 citation statements)

References 21 publications

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“…On June 30, 2016, the military changed their policy regarding transgender individuals, allowing them to serve openly (Rosentel, Hill, Lu, & Barnett, ; Spencer, ). The visibility of transgender veterans is thus increasing, even in the midst of confusion about their status in the military, and a sometimes hostile political environment (Hirschfeld Davis & Cooper, ).…”

Section: Discussionmentioning

confidence: 99%

Military Sexual Assault in Transgender Veterans: Results From a Nationwide Survey

Beckman

Shipherd

Simpson

et al. 2018

Journal of Traumatic Stress

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There is limited understanding about the frequency of military sexual assault (MSA) in transgender veterans, characteristics associated with MSA, or subsequent mental and behavioral health problems. To address this gap, we used an online national survey of 221 transgender veterans to identify prevalence of MSA and to assess its association with demographic characteristics, past history of sexual victimization, and stigma-related factors. We also evaluated the association between MSA and several mental and behavioral health problems. Overall, 17.2% of transgender veterans experienced MSA, but rates differed significantly between transgender women (15.2%) and transgender men (30.0%). Using adjusted regression models, MSA was associated with adult sexual assault prior to military service, odds ratio (OR) = 4.05, 95% CI [1.62, 10.08], and distal minority stress during military service, OR = 2.98, 95% CI [1.28, 6.91]. With respect to health outcomes, MSA was associated with past-month posttraumatic stress disorder (PTSD) symptom severity, B = 10.18, 95% CI [3.45, 16.91]; current depression symptom severity, B = 3.71, 95% CI [1.11, 6.30]; and past-year drug use, OR = 3.17, 95% CI [1.36, 7.40]. Results highlight the vulnerability of transgender veterans to MSA, and the need for military prevention programs that acknowledge transgender individuals' heightened risk. Furthermore, clinicians should consider clinical screening for PTSD, depression, and drug use in transgender veterans who have a history of MSA.

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Section: Discussionmentioning

confidence: 99%

Military Sexual Assault in Transgender Veterans: Results From a Nationwide Survey

Beckman

Shipherd

Simpson

et al. 2018

Journal of Traumatic Stress

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“…19 In an investigation of the health care experiences of transgender veterans, participants reported experiencing insensitivity, harassment, and violence while seeking care and that VHA providers lacked knowledge about transgender care. 20 Unfortunately, no known studies exist regarding the effects of discrimination on health behaviors and overall health among LGBT veterans.…”

Section: Introductionmentioning

confidence: 99%

Lesbian, Gay, Bisexual, and Transgender Veterans' Experiences of Discrimination in Health Care and Their Relation to Health Outcomes: A Pilot Study Examining the Moderating Role of Provider Communication

et al. 2019

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Purpose: Lesbian, gay, bisexual, and transgender (LGBT) veterans report discrimination in health care, which may be associated with negative health outcomes/behaviors and has implications for LGBT identity disclosure to providers. Quality provider communication may serve to offset some of the deleterious effects of discrimination; however, no research to date has examined provider communication with respect to health among LGBT patients.Methods: Participants were 47 LGBT veterans who completed measures related to past health care experiences, experiences of discrimination in health care, perceptions of provider communication, and measures of anxiety, depression, post-traumatic stress disorder symptoms, and alcohol/tobacco use.Results: The majority of LGBT veterans reported experiencing LGBT-based discrimination in health care, which was associated with higher rates of tobacco use and less comfort in disclosing their LGBT identity to providers. We also found evidence of moderation, such that high-quality provider communication appeared to buffer these associations.Conclusion: LGBT veterans face unique challenges with respect to receiving appropriate health care. The high frequencies of reported discrimination in health care is problematic and warrants further research and intervention. These results highlight the important role of provider communication, and the potential for quality communication to buffer against certain effects, particularly with respect to tobacco use and LGBT identity disclosure, which is an important protective factor.

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“…In a sample of nearly 250 third- and fourth-year medical students, only 56% chose the correct definition of the term “transgender” [31]. Unsurprisingly, some of the frequently cited barriers to accessing care among transgender patients are the lack of knowledgeable providers (regarding body, identity, expression, etc, for transgender patients and transgender-specific care) [15,32,33] or the need for the patient to educate the provider [4], which may be magnified for patients in rural and remote locations [22,34]. Although medical training and curriculum need to include transgender topics [35], health systems face a concomitant, immediate need to equip current providers with necessary resources in order to provide transgender-specific health care for transgender patients.…”

Section: Discussionmentioning

confidence: 99%

Utilization of the Veterans Affairs’ Transgender E-consultation Program by Health Care Providers: Mixed-Methods Study

et al. 2019

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Background In 2015, the Department of Veterans Affairs (VA) nationally implemented a transgender e-consultation (e-consult) program with expert clinical guidance for providers. Objective This mixed-methods project aimed to describe providers’ program experiences, reasons for nonuse of the program, and ways to improve the program use. Methods From January to May 2017, 15 urban and rural VA providers who submitted at least one e-consult in the last year participated in semistructured interviews about their program experiences, which were analyzed using content analysis. From November to December 2017, 53 providers who encountered transgender patients but did not utilize the program participated in a brief online survey on the reasons for nonuse of the program and the facilitators encouraging use. Results Qualitative analysis showed that providers learned of the program through email; colleagues; the electronic health record (EHR) system; and participation in the VA Lesbian, Gay, Bisexual, and Transgender committees or educational trainings. Providers used the program to establish care plans, hormone therapy recommendations, sexual and reproductive health education, surgical treatment education, patient-provider communication guidance, and second opinions. The facilitators of program use included understandable recommendations, ease of use through the EHR system, and status as the only transgender resource for rural providers. Barriers to use included time constraints, communication-related problems with the e-consult, impractical recommendations for underresourced sites, and misunderstanding of the e-consult purpose. Suggestions for improvement included addition of concise or sectioned responses, expansion of program awareness among providers or patients, designation of a follow-up contact person, and increase in provider education about transgender veterans and related care. Quantitative analysis showed that the common reasons for nonuse of the program were no knowledge of the program (54%), no need of the program (32%), and receipt of help from a colleague outside of e-consult (24%). Common suggestions to improve the program use in quantitative analyses included provision of more information about where to find e-consult in the chart, guidance on talking with patients about the program, and e-mail announcements to improve provider awareness of the program. Post hoc exploratory analyses showed no differences between urban and rural providers. Conclusions The VA transgender e-consult program is useful for providers, but there are several barriers to implementing recommendations, some of which are especially challenging for rural providers. Addressing the identified barriers and enhancing the facilitators may improve program use and quality care for transgender veterans.

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Transgender Veterans and the Veterans Health Administration: Exploring the Experiences of Transgender Veterans in the Veterans Affairs Healthcare System

Cited by 34 publications

References 21 publications

Military Sexual Assault in Transgender Veterans: Results From a Nationwide Survey

Military Sexual Assault in Transgender Veterans: Results From a Nationwide Survey

Lesbian, Gay, Bisexual, and Transgender Veterans' Experiences of Discrimination in Health Care and Their Relation to Health Outcomes: A Pilot Study Examining the Moderating Role of Provider Communication

Utilization of the Veterans Affairs’ Transgender E-consultation Program by Health Care Providers: Mixed-Methods Study

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