Increasing Access to Care for Transgender and Gender Non-Binary Survivors: Lessons Learned
By Kristen Parsons, Research Associate
In 2020, the Mount Sinai Center for Transgender Medicine and Surgery introduced the Trauma Healing and Resilience Initiative for Transgender Survivors of Violence initiative, which offers trauma-informed services for transgender and gender non-binary (TGNB) survivors.
Transgender and gender non-binary (TGNB) individuals experience higher rates of violence and mental health challenges compared to cisgender persons. In a 2015 survey of nearly 28,000 transgender people, 54% had experienced some form of intimate partner violence, and approximately half (47%) were sexually assaulted at some point in their lifetime. In addition, 39% had experienced significant psychological distress in the past, and 40% had attempted suicide at some point in their lifetime compared to only 5% of the US population. TGNB individuals also face significant barriers to care when they experience victimization. Indeed, 58% of survey respondents indicated they were previously denied equal treatment or service.
The Mount Sinai Center for Transgender Medicine and Surgery (CTMS) aims to reduce barriers to service access for TGNB individuals through the Trauma Healing and Resilience Initiative for Transgender Survivors of Violence (THRIV). The Initiative is part of the New York County District Attorney’s Office (DANY) Criminal Justice Investment Initiative (CJII) and began offering services at CTMS in 2020. THRIV offers individual and structured group therapy; a peer support group; internal and external referrals; and an educational speaker series designed to increase awareness of trauma-informed and trans-specific practices among participants and in-house staff. As of August 2021, THRIV had served 45 participants and had delivered six trainings to 321 hospital employees.
Interim findings from an ongoing evaluation indicate that CJII funding allowed Mount Sinai to offer culturally competent care to TGNB survivors and to enhance knowledge of trans-specific care among broader hospital staff through the speaker series. Findings also emphasized that THRIV services for TGNB survivors were particularly important during the onset of COVID-19, which affected this population in several unique ways.
THRIV Enhanced Participants’ Trauma Processing and Self-View
Participants reported that the program improved several aspects of their overall wellbeing. First, THRIV provided them with a safe space to address complex trauma histories with other supportive members of TGNB community. Participants unanimously agreed that their trusting relationship with the THRIV clinician was key to their experience, with some noting that this was the first time they had felt respected in a medical setting. In addition, participants appreciated learning skills related to communication, articulating needs, trauma processing, and self-care, among others. Participants also experienced improved feelings of self-worth, empowerment and ability to self-advocate, and sense of belonging to a community. One participant shared, “I feel empowered. I feel like my voice matters.”
In-House Trainings Expanded Hospital Staff Knowledge of Trans-Specific Care
THRIV also improved hospital staff knowledge of gender-affirming care. As of August 2021, THRIV has delivered six trainings to more than 300 employees as of August 2021 covering transgender mental health, the impact of racial and gender-based violence on complex trauma, and providing tailored care to TGNB patients in the emergency department. Interviews with attendees revealed that they had no prior training on working with trans patients, and thus, the trainings offered by THRIV were viewed as significantly helpful. According to one physician, “This was the best talk I’ve ever attended and should be mandatory for all medical staff.”
COVID-19 Exacerbated the Need for Services Tailored to Transgender Survivors
During the onset of COVID-19, widespread service disruptions inhibited access to care for TGNB survivors who already faced significant barriers to services before the pandemic. For example, 35% of THRIV participants reported being harassed by a service provider at some point in their lifetime.[1] Coupled with the high transmission rate of COVID-19 and being in close proximity to other residents, THRIV participants required and received additional support to swiftly identify other housing accommodations.[2]
About the Evaluation
The evaluation of THRIV, conducted by the Icahn School of Medicine (Icahn), is funded through the Criminal Justice Investment Initiative (CJII) of the Manhattan District Attorney’s Office (DANY). The mid-evaluation findings demonstrate how THRIV supports TGNB participants through trans-affirming and trauma-informed services; enhances hospital staff knowledge of trans-affirming care; and helped fill the gap in service delivery at the onset of the COVID-19 pandemic. Icahn plans to conduct additional participant focus groups as well as interviews with THRIV staff and referral agencies. The final evaluation findings will be published in early 2023.
About the Criminal Justice Investment Initiative (CJII)
The Manhattan District Attorney’s Criminal Justice Investment Initiative (CJII) focuses on three investment areas—crime prevention, reentry and diversion, and supports for survivors of crime. THRIV is funded through the Increase Access to Survivors of Crime Initiative, which aims to break down barriers to care for survivors of traditionally underserved groups, such as LGBTQ individuals and people of color, thereby improving public safety. All participants served by THRIV as of August 2021 identified as transgender women (73%), transgender men (14%) or gender non-binary/genderqueer (13%). Half of patients were Black/African American (30%) or Hispanic/Latinx (17%); an additional 35% were white and 17% were Asian. The CUNY Institute for State &Local Governance manages and provides technical assistance to CJII contractors and conducts oversight and performance measurement throughout the lifetime of the initiative.
[1] Connolly, P., Young, E., Rader, S. & Ham, J. (October 2021).
[2] Ibid.