Working with TGD clients in general practice

• Although the client may not require occupational therapy for a gender-specific reason, it is important to factor their gender identity into the evaluation along with how their gender may impact their performance.
• The client’s medical history, occupational profile, and current deficits should allow for the creation of a client-focused plan of care (American Occupational Therapy Association, 2020).
• Practitioners should be aware of family and friend dynamics and confirm how the client wants to be addressed when family members or friends are present. This ensures that HIPAA laws are not violated and protects the client and their well-being.

When performing standardized or observational assessments, the OTP wants to obtain baseline data as well as where the client was prior to their current impairment.

• If the assessment being used only has scores normed by gender, either use the male/female score average or simply report the raw score.
• For example, if measuring a TGD client’s grip strength, report their baseline strength. As the client makes progress, the OTP can reassess grip strength and report improvement in their scores.
• The OTP should perform an analysis of occupational performance as is typical for all clients. Client factors, such as being transgender or gender diverse, influence an individual's performance in their occupations.

The Occupational Therapy Practice Framework: Domain & Process, 4^th edition (OTPF-4; AOTA, 2020) is one framework available to OTPs while working with TGD clients.

• Promote health, well-being, and participation in life through this framework and encourage active engagement in meaningful occupations.
• Consider gender identity during interventions to address mental health, self-advocacy, and self-empowerment (AOTA, 2020).

• Assists practitioners to better understand the client’s needs in relation to gender minority stress and resilience which can help guide the intervention if applicable.

• OTPs can use cultural humility to create treatment plans and keep the client involved in goals (Agner, 2020).
• Personal biases and expectations may impact what occupations an OTP would consider for a TGD client.
• Remember that every client is unique and their experience with being TGD is unique as well.

• Due to prior negative experiences with healthcare practitioners or healthcare systems, TGD clients may avoid, delay, or be inconsistent with seeking healthcare services (Lambda Legal, 2010).
• Practitioners can use therapeutic use of self, cultural humility, and inclusive resources to provide a welcoming, positive, and safe environment.

Occupational therapy practitioners should report outcomes as usual. If a standardized assessment cannot be used, the OTP should use other measures to demonstrate a change in occupational performance and quality of life.

• Qualitative measures (interviews and observations)
• Quantitative data (numerical post-intervention assessment)