DEIJAB TOOLKIT: Transgender & gender-diverse care

Promoting LGBTQIA+ inclusive environments

Co-led Authors—Capstone students: Bri Guillory, OTS, Boston University and Lili Rafalski, OTS, Emory & Henry College 08/10/2023

How can occupational therapy promote an inclusive environment? Occupational therapy practitioners (OTPs) can provide culturally inclusive services by incorporating cultural humility into practice when working with clients with different genders, sexuality, backgrounds, cultures, religions, and traditions.

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Hospitals & clinics

Discover ways to promote an inclusive environment for your clients in the hospital and clinic settings.

- Have a visible non-discrimination policy that includes gender identity and sexual orientation lays the foundation for an inclusive environment and signals to LGBTQIA+ clients that the organization is dedicated to equal access for all.
- Visit The Human Rights Campaign (n.d.) website gives examples of various policies and suggestions for content under their HEI Scored Questions-Serving Transgender Patients FAQ section on the Transgender Patient Services and Support page.
- Place proposed policies in high-visibility areas such as in waiting rooms, on intake forms, on websites, and in treatment areas.
- Display these policies and enforce them! This may be the difference between a client forgoing care and choosing to follow through.
- Include a non-discrimination policy that has a gender identity and sexual orientation to fulfill certain accreditation standards (National Academies of Sciences, Engineering, and Medicine, 2020; Coleman et al., 2022.
- Place LGBTQIA+ symbols, such as the Human Rights Campaign equality symbol, Safe Zone signage, lanyards, or Pride flags immediately tells clients that the environment is LGBTQIA+ friendly.
- Display magazines, brochures or other advertising materials that are inclusive (e.g., nonprofit LGBTQIA+ organization, trans-friendly locations, etc.).
- Share Sexual Orientation and Gender Identity Questions: Information for Patients, a pamphlet from the National LGBTQIA+ Health Education Center (2021), with patients in waiting and/or exam rooms. This pamphlet is available in several languages.
- Single restrooms can be labeled for all genders to ensure privacy and safety for all clients
- If gender-segregated bathrooms are required, also having a gender-neutral restroom allows for client comfort and safety.
Use open-ended questions to allow the patient room to provide relevant information without possible cisnormative and heteronormative assumptions.
- Legal name
- Name used
- Pronouns
- Spouse
- Parent
- Caregiver
- Protect LGBTQIA+ clients and staff members by having anti-discrimination and anti-harassment policies.
- Require training specific to the LGBTQIA+ population, discriminations they face, and health disparities.
- Require training specific to the transgender and gender diverse (TGD) population, discriminations they face, and health disparities.
- Recognize that LGBTQIA+ status falls under the Health Insurance Portability and Accountability Act of 1996.
- Recognize that outing a transgender co-worker, supervisor, or other staff member can compromise their safety and should not be treated as office gossip. Employers can add internal policies to remind staff that outing an individual is not tolerated.
- Create support programs and networking opportunities for LGBTQIA+ employees.
- Data fields should be inclusive and include sections for: name used, pronouns, and current gender identity.
- Not all EMR systems automatically include a place for sexual orientation and gender identity (SOGI) information. An effort should be made to collect SOGI information when relevant and applicable.
- Consider whether your clinic or hospital genuinely has a need for a client’s sex assigned at birth, and if not, consider removing that language from forms.

Higher education institutions

An inclusive classroom environment allows for positive social and academic outcomes. Schools can have binary gender systems that contribute to occupational alienation and injustice to transgender and gender diverse students, faculty, and staff. Institutional cisgenderism in academics leads to privilege for individuals who identify as cisgender and contributes to the invisibility and isolation of transgender and gender diverse (TGD) people.

- Limiting labels of individuals to male or female (cisnormativity).
- Implementing social norms that are not flexible to individuals that express their gender outside of the gender binary, which can contribute to alienation and/or violence.
- Promoting isolation and alienation due to gender-segregated spaces, active or passive transphobia, or other trans exclusionary practices (employment, women’s/men’s residence halls, campus clubs and organizations, and gendered bathrooms).
1. Offer educational opportunities, campus programming, and support for trans individuals.
  - Provide trans-inclusive educational content resources and classroom curricular.
  - Offer trans-inclusive campus programs, organizations, and spaces.
  - Employ health professionals and counselors who are competent in transgender and gender-diverse health needs.
  - Provide all-gender and/or gender-neutral restrooms.
2. Improve university systems and procedures for recording one’s name and gender
  - Provide diverse options for gender, pronouns, and sex in campus forms.
  - Provide “name used” or “chosen name” space in campus forms and allow individuals to change the name and/or gender on records without a legal name/gender change.
  - Provide an easy and accessible way for individuals to change their name and/or gender in campus records.
3. Encourage greater inclusivity and recruitment of diverse groups.
  - Recruit and retain TGD people, people of color, people with disabilities, first generation students, etc., through scholarships, presence of the mentioned identities within faculty and staff, support groups and resources, and administrator actions.
4. Gender-inclusive facilities
  - Provide gender-neutral/all-gendered residence halls, locker rooms, and bathrooms.
5. Make people responsible
  - Hold people accountable when they demonstrate discrimination, violence, and/or mistreatment towards TGD people.
(Seelman, 2014)

References

View references on promoting LGBTQIA+ inclusive environments.

Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L. C., Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F. L., Monstrey, S. J., Motmans, J., Nahata, L., … Arcelus, J. (2022). Standards of care for the health of transgender and gender diverse people, version 8. International Journal of Transgender Health, 23(Suppl. 1), S1–S259. https://doi.org/10.1080/26895269.2022.2100644

Human Rights Campaign Foundation. (n.d.) Transgender patient services and support. https://www.thehrcfoundation.org/professional-resources/transgender-patient-services

National Academies of Sciences, Engineering, and Medicine. (2020). Understanding the well-being of LGBTQI+ populations. The National Academies Press. https://doi.org/10.17226/25877

National LGBTQIA+ Health Education Center. (2021). Ten strategies for creating inclusive health care environments for LGBTQIA+ people. https://www.lgbtqiahealtheducation.org/wp-content/uploads/2021/05/Ten-Strategies-for-Creating-Inclusive-Health-Care-Environments-for-LGBTQIA-People-Brief.pdf

Seelman, K. L. (2014). Recommendations of transgender students, staff, and faculty in the USA for improving college campuses. Gender and Education, 26(6), 618–635. https://doi.org/10.1080/09540253.2014.935300

Waiting rooms

Gender neutral restrooms

Affirming language and gender identity

Internal practices

Data fields in certified Electronic Health Records (EHRs)

Examples of the binary gender systems in academics

5 ways to be more transgender and gender-diverse (TGD) inclusive in academics