a practical guide to trans, gender diverse and non-binary inclusion September 2019 | © cohealth 2019 our commitment We are proud to release ‘A practical guide to trans, gender diverse and non-binary inclusion’, a guide providing cohealth staff with the necessary knowledge and skills to ensure a culturally safe and inclusive environment, helping us work congruently with our core values of social equity and respect. At cohealth, we are committed to providing responsive health and community services that respect the human rights of all people, celebrates their diversity and promotes their participation in all aspects of their health and wellbeing. We want all trans, gender diverse and non-binary co-workers and consumers to feel welcome and a sense of belonging when they Nicole Bartholomeusz Chief Executive of cohealth walk through cohealth’s doors. These guidelines are an important step in achieving this. This document has been written in collaboration with the Zoe Belle Gender Collective (ZBGC) and LGBTIQ Education & Advocacy Project (LEAP). cohealth would particularly like to thank Starlady (ZBGC) and Jeremy Wiggins (LEAP) for their valuable contributions. This guide has been informed by the National LGBT Health Education Centre’s, Affirmative Care for Transgender and Gender Non-Confirming People resource. We acknowledge the traditional custodians of the land on which our offices stand and we pay our respects to Elders past and present. We acknowledge the sorrow of the Stolen Generations and the impacts of colonisation on Aboriginal and Torres Strait Islander peoples. We also recognise the resilience, strength and pride of the Aboriginal and Torres Strait Islander communities. 3 A practical guide to trans, gender diverse and non-binary inclusion | September 2019 introduction basic terminology Many trans, gender diverse and non-binary (TGDNB) people Cisgender: a person who exclusively identifies with their gender experience stigma and discrimination in their day-to-day lives, assigned at birth. particularly when seeking health care. As a result, many fear they will be treated disrespectfully by health care staff, which can Gender diverse: an umbrella term that is used to describe gender lead to them delaying access to necessary health care services. identities that demonstrate a diversity of expression beyond the Similarly, TGDNB people can experience barriers to employment binary framework of male and female. and may fear being excluded or discriminated against in the Gender identity: our internal sense of self that may be masculine, workplace. feminine, neither, both or moving around freely. cohealth is committed to providing culturally safe and inclusive Gender marker: Markers that denote someone’s gender identity environments, evidenced by our human rights-based practice (for example, M, F or X). and promotion of social and health equity. Cultural safety occurs when individuals feel safe to bring their whole selves to cohealth, Gender pronouns: the pronouns used to describe gender, for cohealth staff showing support where there is no denial or challenge of their identity. All staff example: he/him/his, they/them/theirs, she/her/hers. to the LGBTIQ community during are responsible for creating an environment that responds to the Wear It Purple Day Misgendering: the deliberate or accidental use of a pronoun, needs of TGDNB people. title, or other gendered language that does not match a person’s This guide provides co-workers with a clear understanding of how gender identity. to create a safe and inclusive service and workplace for TGDNB Misnaming/deadnaming: the deliberate or accidental use of an people. It explains duty of care as well as legal obligations of anti- old name or legal name instead of a person’s chosen name. discriminatory practice. Pronoun cueing: the deliberate use of words or actions to send a This guide will provide practical advice on: ‘cue’ to others about someone’s gender and preferred pronouns. • Inclusive communication Non-binary: a broad term referencing gender identities and/or • Safe disclosure and maintaining confidentiality experiences that aren’t exclusively male or female. • Welcoming and safe environments Transgender/trans: a person who does not exclusively identify with their gender assigned at birth. 4 5 A practical guide to trans, gender diverse and non-binary inclusion | September 2019 inclusive communication Inclusive communication is a way to demonstrate respect, build Some people introduce their own pronoun first, for example trust and address exclusion and discrimination that TGDNB people “Hello, I am Toni, I’ll be your GP today and my pronouns are face. TGDNB people often change their pronouns, names and/ Tip! they, them, theirs. Would you like me to record what pronouns or gender markers to better reflect their gender identity. Some and/or titles you would like to use at this service?” people change them officially on their legal documents, while Create an environment of If you do make a mistake, you can say something like: some do not (for various reasons). accountability. Use pronoun “I’m cueing to help your co- sorry for using the wrong pronoun/name. I did not mean to It’s important to affirm and respect everyone’s gender identity workers. Don’t be afraid disrespect you. Let me try again” and how they would like to be referred to. This right is protected to politely correct your One way to prevent misgendering is to avoid using terms that through the Commonwealth Sex Discrimination Amendment colleagues if they use the indicate gender when you address people you don’t know. (Sexual Orientation, Gender Identity and Intersex Status) Act 2013. wrong names and pronouns, or if they make insensitive For example, instead of asking “How may I help you, sir?” you comments. Constantly having can simply ask, “How may I help you?” You can also avoid Greeting people to correct others can be using “Mr./Mrs./Miss/Ms.” by calling someone by their chosen exhausting for TGDNB people name or by using their first and last name together. It is essential not to make assumptions about someone’s gender so having colleagues take on identity based on their name, how they look, their mannerisms or responsibility helps remove It is also important to avoid gendered terms when talking to others how they sound. Misgendering, misnaming or deadnaming are some of that burden. about someone whose gender identity is not yet known to us. the most common forms of systemic discrimination that impact TGDNB people and can cause significant distress. If you are For example, rather than saying “he/she needs a follow-up unsure about a person’s affirmed name and pronoun, politely appointment” you can say “The consumer is here in the ask. If you make a mistake about a person’s name or pronoun, waiting room” or “Dr Reed’s 11:30 consumer is here.” You can politely apologise and try to remember next time. Be aware that also use “they” instead of “she” or “he”. For example, you can some questions related to gender are personal and discretion say: “They are here for their 3pm meeting.” is important. The following script can be used as a guide to ask Once a person has disclosed their chosen name, gender identity someone about their pronouns or gender identity: and pronouns, it is important to use their preferences in all future Try asking: “What pronouns do you use?” or “How would you correspondence and continue to use them even when they are describe your gender identity?” It can feel uncomfortable not present (if they have given permission). if you are not used to asking this question but making an assumption about someone’s pronoun is more uncomfortable. 6 7 A practical guide to trans, gender diverse and non-binary inclusion | September 2019 Recording personal details safe disclosure and Consumers are provided with a registration form at their first cohealth visit and are invited to include optional information about their gender identity, sexuality and intersex variation status. This information helps cohealth to provide inclusive services that maintaining confidentiality meet the healthcare needs of consumers. Importantly, this section provides an opportunity for people who are TGDNB to self-identify how they would like their gender identity, pronouns and name to be recorded. It is important that you ask questions about gender identity Sometimes you might find that the name on a person’s and pronoun preferences in an affirming and respectful way. It identification and Medicare card is different from the one they Tips! sends a message to TGDNB people that they are recognised, would like to record in cohealth’s systems. It is important that you acknowledged and valued. Best practice is to explain why - It is important not to are prepared for this possibility and that you record the name and information about a consumer’s gender identity may be relevant misgender or deadname gender the consumer discloses upon registration. and to remind them that disclosure is optional. Respectful consumers when making responses to disclosure and confidentiality are integral to a referrals. In a situation where a consumer’s name or gender does not TGDNB person’s experience of a service and workplace. It’s match their Medicare card or medical records, you can ask: - Sometimes people aren’t important to balance creating invitations for people to disclose “Could your records be under a different name?” or “What is “out” with their gender with their right to privacy. the name on your Medicare card?” It may be useful to explain identity in all settings, so why you need this information, for example: “We need this Consumers should be reassured that any information they you need to make sure you information for our billing purposes.” You can then cross-check provide will be stored securely, remain confidential, and only be won’t be placing them at identification by looking at date of birth and address.