Identify, Engage, Understand: Supporting Transgender Youth in an Inpatient Psychiatric Hospital
- 151 Downloads
Transgender adolescents may require for inpatient psychiatric care, and have unique healthcare needs and can face barriers to quality care. This study sought to address limited understanding of the inpatient experience of transgender adolescents. This study uses qualitative methods to gain insight into the experience of transgender adolescents and psychiatric care providers on an adolescent inpatient psychiatric unit in the northeast United States. Semi-structured interviews were conducted with patients (9 total, ages 13–17) and unit care providers (18 total). These interviews were recorded, transcribed, and analyzed using inductive thematic analysis. Patients and providers generally reported a supportive inpatient environment. Factors that contributed to this environment were efforts by care providers to respect patients regardless of gender identity, to use patient’s preferred identifiers, and to acknowledge mistakes in identifier use. Barriers to consistently supportive interactions were also identified, including a lack of consistent identification of a patient’s transgender identity in a supportive manner during the admission intake, challenges associated with the presence of birth-assigned name and gender within the care system (e.g. in the electronic medical record, identifying wristbands, attendance rosters), and a lack of formal training of care providers in transgender cultural competency. Interviews also provided insight into how providers grapple with understanding the complexities of gender identity. Findings suggest that gender-affirming approaches by providers are experienced as supportive and respectful by transgender adolescent patients, while also identifying barriers to consistently supportive interactions that can be addressed to optimize care.
KeywordsTransgender Gender identity Affirmative model Inpatient experience Adolescents
Compliance with Ethical Standards
Conflict of Interest
Authors Turban and van Schalkwyk are currently co-editing a textbook on pediatric gender identity for Springer.
Informed assent was obtained from all patient participants, explaining study procedures and the voluntary nature of their participation. Patients who agreed to participate were then asked for permission to contact their legal guardian for informed consent. Informed consent was also obtained from care providers who participated voluntarily.
All procedures performed were in accordance with ethical standards of the institutional research committee of the participating hospital system. Approval was obtained from the Institutional Review Board prior to study initiation.
- 3.Flores AR, Herman JL, Gates GJ, Brown TNT. How many adults identify as transgender in the United States. Los Angeles: The Williams Institute; 2016.Google Scholar
- 4.Shields JP, Cohen R, Glassman JR, Whitaker K, Franks H, Bertolini I. Estimating population size and demographic characteristics of lesbian, gay, bisexual, and transgender youth in middle school. J Adolesc Health. 2013;52(2):248–50. https://doi.org/10.1016/j.jadohealth.2012.06.016.CrossRefPubMedGoogle Scholar
- 5.Clark TC, Lucassen MF, Bullen P, Denny SJ, Fleming TM, Robinson EM, et al. The health and well-being of transgender high school students: results from the New Zealand adolescent health survey (Youth'12). J Adolesc Health. 2014;55(1):93–9. https://doi.org/10.1016/j.jadohealth.2013.11.008.CrossRefPubMedGoogle Scholar
- 7.Skagerberg E, Davidson S, Carmichael P. Internalizing and externalizing behaviors in a group of young people with gender dysphoria. Int J Transgend. 2013;14(3):105–12. https://doi.org/10.1080/15532739.2013.822340.
- 8.Steensma TD, Zucker KJ, Kreukels BP, Vanderlaan DP, Wood H, Fuentes A, et al. Behavioral and emotional problems on the Teacher's report form: a cross-national, cross-clinic comparative analysis of gender dysphoric children and adolescents. J Abnorm Child Psychol. 2014;42(4):635–47. https://doi.org/10.1007/s10802-013-9804-2.CrossRefPubMedGoogle Scholar
- 11.de Vries AL, Steensma TD, Cohen-Kettenis PT, VanderLaan DP, Zucker KJ. Poor peer relations predict parent- and self-reported behavioral and emotional problems of adolescents with gender dysphoria: a cross-national, cross-clinic comparative analysis. Eur Child Adolesc Psychiatry. 2016;25(6):579–88. https://doi.org/10.1007/s00787-015-0764-7.CrossRefPubMedGoogle Scholar
- 12.Grant JM, Mottet L, Tanis J, Harrison J, Herman J, Keisling M. Injustice at every turn: a report of the national transgender discrimination survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force; 2011. Retrieved from https://endtransdiscrimination.org/PDFs/NTDS_Exec_Summary.pdf. Accessed March 2019.
- 13.James SE, Herman JL, Ranklin S, Keisling M, Mottet L, Anafi M. Executive summary of the report of the 2015 transgender survey. Washington, DC: National Center for Transgender Equality; 2015. Retrieved from https://www.transequality.org/sites/default/files/docs/USTS-Full-Report-FINAL.PDF. Accessed March 2019.
- 16.Alastanos JN, Mullen S. Psychiatric admission in adolescent transgender patients: a case series. Ment Health Clin. 2017;7(4):172–5. https://doi.org/10.9740/mhc.2017.07.172.
- 20.Safer JD, Coleman E, Feldman J, Garofalo R, Hembree W, Radix A, et al. Barriers to health care for transgender individuals. Curr Opin Endocrinol Diabetes. 2016;23(2):168–71. https://doi.org/10.1097/MED.0000000000000227.
- 21.When Health Care Isn’t Caring: Lambda Legal’s Survey of Discrimination Against LGBT People and People with HIV. New York City: Lambda Legal; 2010. Retrieved from https://www.lambdalegal.org/sites/default/files/publications/downloads/whcic-report_when-health-care-isnt-caring.pdf. Accessed March 2019.
- 22.Chisolm-Straker M, Jardine L, Bennouna C, Morency-Brassard N, Coy L, Egemba MO, et al. Transgender and gender nonconforming in emergency departments: a qualitative report of patient experiences. Transgend Health. 2017;2(1):8–16. https://doi.org/10.1089/trgh.2016.0026.
- 23.Deutsch MB, Green J, Keatley J, Mayer G, Hastings J, Hall AM. Electronic medical records and the transgender patient: recommendations from the World Professional Association for Transgender Health EMR Working Group. J Am Med Inform Assoc. 2013;20(4):700–3. https://doi.org/10.1136/amiajnl-2012-001472.CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Creating Equal Access to Quality Health Care for Transgender Patients, Transgender-Affirming Hospital Policies. New York City: Lambda Legal, Human Rights Campaign Foundation, Hogan Lovells US LLP, New York City Bar Association; 2016. Retrieved from https://www.lambdalegal.org/sites/default/files/publications/downloads/fs_20160525_transgender-affirming-hospital-policies.pdf. Accessed March 2019.
- 25.Curtis R, Levy A, Martin J, Playdon Z, Wylie K, Reed T, et al. Guidance for GPs, other clinicians and health professionals on the care of gender variant people. London: Dept of Health; 2008. Retrieved from https://www.nelft.nhs.uk/download.cfm?doc=docm93jijm4n1063.pdf&ver=1226. Accessed March 2019.
- 26.National LGBT Health Education Center. Affirmative care for transgender and gender non-conforming people: best practices for front-line health care staff. Boston: The Fenway Institute; 2016. Retrieved from https://www.lgbthealtheducation.org/wp-content/uploads/2016/12/Affirmative-Care-for-Transgender-and-Gender-Non-conforming-People-Best-Practices-for-Front-line-Health-Care-Staff.pdf. Accessed March 2019.
- 33.Wingerson L. Gender identity disorder: has accepted practices caused harm? Psychiatric Times; 2009. Retrieved from http://www.psychiatrictimes.com/schizophrenia/gender-identity-disorder-has-accepted-practice-caused-harm. Accessed March 2019.
- 34.Institute of Medicine. The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. Washington, DC: The National Academies Press; 2011.Google Scholar
- 35.Leventhal R. The many layers of healthcare’s EHR gender identity problem. Healthc Inform. 2017; Retrieved from https://www.healthcare-informatics.com/article/ehr/many-layers-healthcare-s-ehr-gender-identity-problem. Accessed March 2019.
- 38.McCarth0079 M. Gender identity and pronoun usage: a guide for pediatric health care professionals. Boston Children’s Hospital’s Clinic Health Blog; 2017. Retrieved from https://notes.childrenshospital.org/clinicians-guide-gender-identity-pronoun-use. Accessed March 2019.
- 39.Ovens H. WTBS 13 transgender patients: how to foster a safer emergency department environment. Emergency Medicine Cases; 2017. Retrieved from https://emergencymedicinecases.com/transgender-patients-emergency-department. Accessed March 2019.
- 40.Burnes TR, Singh AA, Harper AJ, Harper B, Maxon-Kann W, Pickering DL, et al. American counseling association: competencies for counseling with transgender clients. LGBT Iss in Couns. 2010;4(3–4):135–9. https://doi.org/10.1080/15538605.2010.524839.