Trans-Inclusive Care

Ensure trans-inclusive internal policies. Assess organizational policies (e.g. employment, anti-discrimination policies, etc.) regularly, and ensure they are trans-inclusive. Most importantly, gender identity and gender expression should be explicitly included in anti-discrimination and anti-harassment policies. Pay special attention to areas and programs that are segregated by gender, as it is likely that inclusion policies must be created; such policies should state that the person’s gender is that which they identify with, and they should be categorized based on this self-identification (i.e., when assigning beds/rooms for hospitalization). Remember that all policies should be publicly displayed and/or available.

Develop policies for trans-specific health services. If the organization has policies for medication, make sure that there are protocols for hormone therapies. These protocols should include ensuring privacy for clients, access to these medications and access to needles and syringes if needed.

Foster trans visibility among staff. Similar to recommendations pertaining inclusive practices for LGBQ individuals, health institutions and organizations can also promote inclusive practices by recruiting and hiring trans-identified staff. Such an approach allows for increased visibility and is also related to equal employment opportunities, and in turn, will also help patients perceive the healthcare setting as less threatening or better navigate the healthcare system.

Provide training for all staff. Train all staff on LGBTQ2 competencies, including trans-specific information. For staff working directly with patients, they should be aware of how someone’s trans identity may impact their mental and physical health experiences to respond in an empathetic manner.

Create a welcoming and inclusive environment for trans-identified folks. Post signage that the agency or institution is an LGBTQ2-inclusive space and does not tolerate discrimination throughout the agency (e.g. a trans flag and/or direct statement of inclusivity). Promotional materials (e.g. leaflets, brochures) should mention that all people are welcome, and that gender identity and expression are respected in the space providing the healthcare service. The service may also wish to advertise in trans-specific spaces (e.g. community organizations, websites, etc.).

Employ trans-inclusive forms and documentation. Intake forms, and all client documentation, should be gender-neutral. If sign-in sheets are used, these can only ask for a preferred name. For medical purposes, information regarding sex assigned at birth and gender identity can be collected through intake forms, although always keeping in mind that patients may not want to disclose this.

Use appropriate identifying information to refer to trans patients. Have an established process for documenting and using first names and pronouns that may differ from a government-issued ID (e.g. asking for pronouns on intake forms and training staff to prioritize this name/pronouns over those on government-issued ID).

Make washrooms trans-accessible. Washrooms, showers, sleeping arrangements, etc. should be gender of choice. This can be made clear with gender-inclusive signage, or having these spaces gender-neutral or private when possible.

Join efforts with external organizations. Collaborate with local, external LGBTQ2 organizations to ensure professional policies and organizational practises are inclusive.

Do your own research. Finding and reading research studies, books, reputable social media and website spaces can provide you with education on the issues that face trans communities.

Use preferred names and pronouns. Attempt to avoid using gendered pronouns, unless you are aware of the specific pronouns that someone uses. If you’re addressing a client for the first time, try to avoid referring to them with gendered terms such as “sir” or “miss.” If your organization does not collect information on preferred pronouns and/or names, it is okay to ask someone about these preferences privately. For example, you can privately state, “I would like to be respectful to you. What name and pronouns would you like me to use when referring to you?

If someone’s name and gender don’t match across documentation. When you are working with a client in situations that may require additional documentation, such as insurance, someone’s name and gender they identify with may not match on their records or legal documentation. This is apparent for LGBTQ2-identified people, but particularly common with trans-identified clients. Addressing this can include: (a) referring to a client with their preferred name and pronouns, (b) requesting if they are aware their records may be under a different name. Avoid referring to other names on record as a “real” name, as this invalidates someone’s preferred name/pronouns.

Apologize when you’ve made a mistake. Sometimes you may make a mistake in addressing a trans person, such as by misgendering them. If this happens, it is important to acknowledge the mistake, apologize and move forward while making a conscious effort to address the person accurately in the future.

Understand your privilege. It is valuable to reflect on your own experience as a cisgender person and consider how being cis offers you privileged access to spaces such as washrooms and healthcare services without significant concerns.

Listen to trans experiences. The experiences of trans people and discrimination are sometimes treated as non-significant. It’s important to engage in conversation with trans people, hear their experiences, and listen to how you can be an ally and provide support to the community in your role as a clinician, and your daily life.

Offer trans-specific services. If possible, trans-specific services (e.g. trans-specific group therapies, peer groups, drop-in times for trans-specific healthcare services) can be offered to the community.