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Gender Affirming Care for the Rehabilitation Professional

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Gender Affirming Care for the Rehabilitation Professional 4/6/2021 Jennifer Stone, PT, DPT, OCS, PHC BEST PRACTICES FOR REHAB Program Director, Evidence In Motion Pelvic Health Physical Therapist, Rehabilitative Services, Mizzou Therapy Services, PROFESSIONALS FOR Columbia, MO Pronouns: She/her Special thanks to Mason Aid, pronouns GENDER AFFIRMING CARE they/them 1 1 After this course, participants will be able to: Provide definitions for at least 3 commonly used terms when defining genders and individuals who identify in different ways across the gender spectrum Name at least 2 reasons why correct use of pronouns is important and explain how to LEARNING incorporate this into medical documentation Discuss the impact of hormone therapy on OUTCOMES the musculoskeletal system and explain how to assist patients who experience musculoskeletal pain during or after hormone therapy Describe the types of gender affirming surgery along with a basic description of rehabilitative considerations post surgically 2 2 1 4/6/2021 Gender Sex Sex assigned at birth Transgender man DEFINITIONS Transgender woman Nonbinary Cisgender Gender dysphoria 3 3 Gender divergent Gender affirming care Transition Social Medical Surgical DEFINITIONS Microaggression Heteronormative Cisnormative Sexuality/sexual orientation 4 4 2 4/6/2021 5 5 Exact prevalence is not known, due to lack of accurate large scale studies Varies per country Estimated 0.7% of American young people identify as gender divergent in some way Nearly 1 million adults in the US are transgender Survey found 12% of millennials identify as gender IMPORTANCE diverse Vulnerable population Increased likelihood of depression, anxiety, self harming behaviors, and suicide, especially among transgender youth Frequently encounter prejudice High risk for verbal, physical, and sexual abuse 6 6 3 4/6/2021 85% of PTs report tolerance vs respect 1% of PTs report full respect 68% report very low to average knowledge about transgender/nonbinary care IMPORTANCE High reported rates of: Depression (44%) Suicidal ideation (54%) Suicide attempts (31%) Excessive drinking (22%) Illicit drug use (36%) 7 7 Transgender youth who socially transition and are supported in their choices have age-normative rates of anxiety and depression IMPORTANCE Gender dysphoria has been proven to improve with gender affirmative care Satisfaction with care is high (80+%) Only approximately 2% report regretting the decisions they have made to adjust their presentation 8 8 4 4/6/2021 IMPORTANCE 9 9 “What’s your pronoun?” Not “preferred pronoun” Common ones: She/her PRONOUNS He/his They/them Zhe/ze Zhir/zir Zhim/mer One 10 10 5 4/6/2021 Mx-pronounced “mix” or “mux” Ind-abbreviation of individual M Misc-abbreviation of miscellaneous Mre-abbreviation of mystery, pronounced GENDER “M’ree” NEUTRAL Msr-combination of miss and sir, ADDRESS pronounced “miser” Myr-pronounced “meer” Pr-abbreviation of “person”, pronounced “per” Sai-pronounced “sai” 11 11 GENDER Police officer vs police man/woman Server vs waitress or waiter NEUTRAL Flight attendant vs stewardess or steward JOB TITLES Salesperson vs salesman/woman 12 12 6 4/6/2021 GENDER IDENTITY Social Development 13 13 Important to remember-transgender is an identity, gender dysphoria refers to distress or degree of social challenges presented by the distress GENDER Gender identity can present very strongly from a young age or be IDENTITY expressed later in life due to social DEVELOPMENT context & other factors Gender and sexuality are not binary, but rather a spectrum 14 14 7 4/6/2021 GENDER AS A SOCIAL CONSTRUCT 15 GENDER & SEXUALITY SPECTRUM 16 16 8 4/6/2021 Social & behavioral development, occurs in stages Approximately age 2-become conscious of physical DEVELOPMENT differences between boys & girls By 3rd birthday-most can easily label themselves OF GENDER Age 4-most have stable sense of identity Also learn “gender behaviors” IDENTITY Crossover play is normal for cisgender children, but may be socially discouraged Research says genderdiverse children typically have this same timeline, but may be taught to suppress 17 17 Some methods of expression for children Hair & clothing style Preferred name Social behaviors Mannerisms that are seen as more CHILDREN & feminine/masculine Children and youth who identify as gender GENDER diverse are likely to be faced with bullying, IDENTITY social pressures, and prejudice Resources: https://www.healthychildren.org/English/a ges-stages/gradeschool/Pages/Support- Resources-for-Families-of-Gender-Diverse- Youth.aspx 18 18 9 4/6/2021 Minority stress model-stigma and prejudice result in added stress beyond that experienced by non gender diverse SOCIAL individuals, which can cause an increase in mental and physical disorders STIGMA Hypertension Asthma Substance abuse Depression/anxiety 19 19 SOCIAL STIGMA 20 20 10 4/6/2021 Distal processes Experiences of rejection and discrimination Non-affirmation of gender identity Verbal & physical abuse MINORITY Employment & housing discrimination STRESS Difficulty with access to medical care Proximal processes PROCESSES Stress as a result of the internalization of prejudice and stigma Internalized transphobia Expectation of being rejected 21 21 How do you create an environment that is GENDER AFFIRMING MEDICAL welcoming and healing to individuals across the CARE MODEL gender & sexuality spectrum? 22 22 11 4/6/2021 Medical discrimination can cause significant harm Multiple documented instances of care providers using incorrect pronouns or names in care episodes shortly prior to an individual’s death by suicide FIRST, DO NO Can worsen anxiety and depression Can lead to incorrect diagnosis (assumption that HARM! every issue is due to hormone use) 20% of transgender/nonbinary (compared to cisgender matched group) have been denied medical care 23% avoided seeking medical care due to past experience 23 23 Assumption that mental health challenges are just due to being transgender (vs brain chemical BROKEN ARM imbalance) SYNDROME Treating the person as transgender/nonbinary first, then a person second (different care plan than a cisgender individual) 24 24 12 4/6/2021 “Outing” people in waiting rooms (why do we call people by their listed first name when bringing back for appointments?) Refusal (explicit or implicit) to use preferred names and/or pronouns NON- AFFIRMING Binary language during patient education BEHAVIORS Dismissal of concerns based on the person’s gender expression Buying into/expressing stereotypes (ex: transgender men do not need to discuss birth control) 25 25 Assumption of cisgender & heteronormative status “Counseling” people away from their NON- gender expression Refusal to facilitate care for desired AFFIRMING outcomes BEHAVIORS Conversion “therapy” Use of counseling or extreme measures (shock therapy, inducing N/V, inducing paralysis) to stop people from expressing their gender identity or sexual orientation 26 26 13 4/6/2021 WHAT DIFFERENCE Inclusive PCP=50% reduction in rates of anxiety and depression CAN A When gender divergent youth have 1 person in their lives who is supportive, HEALTHCARE distress & associated comorbidities PROVIDER significantly decrease MAKE? 27 27 Recognizes gender diversity as a normal GENDER part of human development (not pathologized) AFFIRMATIVE Views gender identity as one’s view of oneself, separate from biologic sex, and which may be fluid or stable over time, and which occurs across a MODEL OF spectrum CARE Components listed on the next few slides Additionally requires psychologic concepts 28 28 14 4/6/2021 Transgender and gender diverse identities are not mental disorders NONPATHOLOGIZING These identities are a normal part of human development and diversity 29 29 CULTURALLY SENSITIVE Recognition that gender expressions may vary across cultures, thus gender identity should be understood through a cultural lens 30 30 15 4/6/2021 Understanding that: FLUID, Gender expression may be fluid over time Gender expression may occur across a spectrum vs NONBINARY, being binary Gender emerges as an interplay of biology, MULTIFACETED development, socialization, and culture 31 31 Mental health challenges (if they arise) are CONCEPTUALIZING likely due to trauma and/or social MENTAL HEALTH stigmatization vs being as a result of the person’s gender 32 32 16 4/6/2021 PSYCHOLOGIC Empathy Capacity to imagine oneself in another’s life, used to CONCEPTS appreciate struggle and experience different from FOR GENDER one’s own Containment AFFIRMATIVE Atmosphere created in a therapeutic relationship that conveys a sense of safety, allowing processing CARE of difficult emotions 33 33 Psychologic Safety • Environment, team, or relationship of support-encourages authenticity and risk taking without fear of PSYCHOLOGIC consequences or retaliation- potential to promote learning, CONCEPTS FOR development, and growth GENDER Zone of proximal development • In the process of learning, there are AFFIRMATIVE concepts that are too challenging and concepts that are too easy. CARE Providers find this zone as the “middle ground” that promotes enough challenge for growth, but not so much as to shut down or traumatize 34 34 17 4/6/2021 Ask for pronoun & preferred name…and USE them! Document in a way that reflects respect for that person’s desires (again, ask them!) SO WHAT Consider your waiting room processes Ask open ended questions about CAN YOU relationships and sexuality, if relevant to DO? your care We shouldn’t be making heteronormative monogamous assumptions about cisgender individuals either Ask for preferred
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