Transgender/Trans* Health

Primary & Emergency Care Access / Consulting Working Group

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Overview – Working Group Outcomes

1) Increase provincial access to trans* friendly and experienced health care providers (including both primary and emergency care)

2) Increase GP comfort/knowledge/ability in prescribing hormone therapy

3) Create low cost and accessible mental health supports throughout the province

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1) Increase provincial access to trans* friendly and experienced health care providers

Recommendation #1•Utilize and expand THiP as the centralized resource to help the trans* community and families navigate and access health care providers provincially

Implementation:•Establish process for GPs to self-identify as trans* friendly•Include wider support to include 'trans friendly' care providers for health related items outside specific trans* needs•Brand THiP website as provincial•Increase telephone support hours

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1) Increase provincial access to trans* friendly and experienced health care providers

Recommendation #2•Formalize a specialized PHSA team providing support to other health care providers and/or direct clinical care

Implementation:•Team would consist of an NP, counsellor, assessor and social worker (linked to Community Support WG)

•Support/expertise as members of and refer other physicians to the RACE line•Model/structure to support the organic growth of where to focus next support in which community.•Team would be ongoing, and evolve as the support needs change

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1) Increase provincial access to trans* friendly and experienced health care providers

Recommendation #3•Utilize technology to provide the trans* population with remote access to health care providers that will deliver hormone prescription assessment and maintenance(linked to recommendation #9 - Increase access to existing psychiatrist, councilor assistance or social workers utilizing technology)

Implementation:•Short-term - (6 month?) task team to identify how technology is being used effectively for remote care, and establish training for identified health care providers•Short-term - Develop how-to use/guidelines•Long term - primary care includes trans* health and is accessible through all health care providers.

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1) Increase provincial access to trans* friendly and experienced health care providers

Recommendation #4•Develop resource (content) to mobilize the trans* community & families (how to be an educated health care consumer)•May also link to Community Supports WG

Implementation:•Develop website content leveraging resources from 2006 and add to THiP website•Ensure content works on mobile devices•Content needs to include full lifecycle support, not just primary care or transition-related care

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2) Increase GP comfort/knowledge/ability in prescribing hormone therapy

Recommendation #5•Develop marketing campaign to demystify trans* Community & hormone therapy (leveraging existing GP marketing/ communication

Implementation:•Focus on developing a marketing campaign  to demystify the process through key messaging. Ensure that the messages are unbundled and clear for GPs to understand•outline the process from concept to delivery•Include pediatric physician support.•Campaign to address support regarding the Mental Health needs before prescribing hormones 

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2) Increase GP comfort/knowledge/ability in prescribing hormone therapy

Recommendation #6•Implement new GP billing code for gender dysphoria and communicate awareness of the new code

Implementation:•Create a new billing code for gender dysphoria (primary billing code) with the following acceptable uses:

– assessment for gender dysphoria, assessments and/or care while undergoing medical/surgical treatment, and possibly post op care

•Code annual use should not be capped and should be 30 min units•Awareness of the code to be distributed through existing channels•Note: billing code would not include counseling support, as this is the same as the needs for all populations.

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2) Increase GP comfort/knowledge/ability in prescribing hormone therapy

Recommendation #7•Develop a processes for trans* specialty GP to communicate with and assist comfort of the family GP in prescribing/ continuing hormone therapy

Implementation:•Process guidelines should include (at the minimum) that family GP is copied on all med recs and that a handover summary is provided to the family GP.•Link to Education WG (consider development of PSP module)

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2) Increase GP comfort/knowledge/ability in prescribing hormone therapy

Recommendation #8•Build awareness of issues for trans people amongst Medical Office Assistants and front desk / reception staff

Implementation:•Develop and deliver a marketing campaign targeting MOAs and reception staff (in physician clinics, and in other care settings). •May include developing a brief video outlining the issues and what MOAs and receptionists can do – similar to “the faces of gender – what you don’t know can hurt us” – developed by prideHealth in Halifax http://www.cdha.nshealth.ca/pridehealth/faces-gender

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3) Create low cost and accessible mental health supports throughout the province

Recommendation #9•Increase access to existing psychiatrist, councilor assistance or social workers utilizing technology

Implementation:•Undertake up-front body of work to develop a model for delivering psychiatrist, counsellor and social worker support utilizing technology. •Incorporate ability to deliver hormone and surgery assessments, and hormone maintenance•Linked to recommendation #3 – Utilize technology to provide the trans* population with remote access to health care providers that will deliver hormone prescription assessment and maintenance•Linked to recommendation #1 – Utilize and expand THiP as the centralized resource to help the trans* community and families navigate and access health care providers provincially

•May also link to Community Supports WG

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3) Create low cost and accessible mental health supports throughout the province

Recommendation #10•Develop content to assist existing health care support providers know what questions to ask (e.g. in the Emergency Department)

Implementation:•Develop content (that can be emailed, posted onto health care provider website and used on pamphlets/newsletter) to assist health care providers on knowing what questions to ask relating to trans* specific mental health•Questions to be developed to support health care providers in asking appropriate questions about physical health, and about body parts & hormone / surgery status, when trans people are presenting in an ED (or with GPs /NPs)

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3) Create low cost and accessible mental health supports throughout the province

Recommendation #11•Provide provincial wide access to publically funded hormone & surgery assessment

Implementation:•Funding•Resolve gaps in the current state:

– Currently youth anywhere in BC (under 25) can access VCH for publically funded assessments

– Currently only adults in VCH can get publically funded assessments– Currently if outside of VCH, adults in most circumstances will have to pay for

assessments themselves•Link to Surgery WG

Interrelationships

Community Support WG

Community Support WG

SurgeryWG

RACE line

RACE line

Deliverthrough

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Community Support WG

EducationWG

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Complexity and Impact MatrixE

ase

of

Imp

lem

en

tatio

n

EASY

HARD

Impact of change.LOW HIGH

1

4

9

2

THiP as centralized resource(S)

Specialized team(S)

Utilize technology(S)

11Publically funded assessments(S)

How to be an educated health care consumer(S)

5 Demystify trans*(S)

6New GP billing code(S)

7Speciality GP to GP process(S)

8Awareness for MOAs & front desk/ reception staff(S)

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What q’s to ask for health care providers(S)

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3 Utilize technology for assessments(S)

Trans* health standard part of primary care(L)