unifying science, education and service to transform lives module 10 clinical issues with...
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Unifying science, education and service to transform livesUnifying science, education and service to transform lives
Module 10Clinical Issues with
Transgender Individuals
A Provider’s Introduction to Substance Abuse for Lesbian,
Gay, Bisexual, and Transgender Individuals
First Edition
A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide
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Clinical Issues With Transgender Individuals
Learning Objectives
Understand “transgender”Understand “transgender” Be familiar with research & dataBe familiar with research & data Be aware of clinical issuesBe aware of clinical issues Understand treatment implicationsUnderstand treatment implications
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Review of TermsReview of Terms
Gender:Gender: femaleness or femininity and maleness or femaleness or femininity and maleness or masculinitymasculinity
Gender Role:Gender Role: masculine or femininemasculine or feminine behaviorsbehaviors
Gender Identity: Gender Identity: inner senseinner sense of oneself, a person’s of oneself, a person’s self-concept, in terms of gender self-concept, in terms of gender
Sexual Orientation: Sexual Orientation: distinct from gender identitydistinct from gender identity, describes one's attraction to, sexual desire for, lust describes one's attraction to, sexual desire for, lust for, romantic attachments to others; lesbian, gay, for, romantic attachments to others; lesbian, gay, bisexual, heterosexualbisexual, heterosexual..
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An umbrellaumbrella term that came from the transgender communities in the 1990s and includes the spectrum and continuumspectrum and continuum of gender of gender identities, expressions, and rolesidentities, expressions, and roles that challenge or expand the current dominant cultural values of what it means to be male or female.
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TranssexualsTranssexuals
Cross-dressersCross-dressers
Drag Queens and Drag KingsDrag Queens and Drag Kings
Bigender, Androgyny, Bigender, Androgyny, Nongendered, Gender-Nongendered, Gender-QueerQueer
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Research and DataResearch and Data
In a recent (1999, 2000) San Francisco study by Dr. Kristin Clements at the San Francisco Department of PublicHealth AIDS Office:
HIV prevalenceHIV prevalence among MTF persons was 35% and 35% and 65%65% among African-American MTFs.
Injection drug use was 34%Injection drug use was 34% among MTF transgender individuals and18%18% among FTM transgender individuals.
55%55% of MTF individuals reported they had been in
alcohol or drug treatment sometime during their lifetimes.
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ResearchResearch
A study from Hollywood, California, (Reback and Lombardi1999) reported that the drugs most commonly drugs most commonly used by MTF transgender individuals were alcohol, used by MTF transgender individuals were alcohol, cocaine/crack, and methamphetaminecocaine/crack, and methamphetamine
Other recent studies of transgender health risks in urban areas around the country , including Boston, New York City, Washington D.C., Chicago, Los Angeles and Houston, show similar results with higher rates of similar results with higher rates of substance abuse in general and higher rates of substance abuse in general and higher rates of substance abuse with HIV prevalence, particularly substance abuse with HIV prevalence, particularly among transgender sex workers.among transgender sex workers.
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Clinical Issues and Clinical Issues and Implications for TreatmentImplications for Treatment
1. Issues about appearance, "passing" and body image
2. History of hiding or suppressing gender identity
3. Lack of family and social support
4. Isolation and lack of connection to positive, proactive transgender community resources
5. Hormone therapy and use or injection history
6. Stigma and discrimination
7. Employment problems
8. Relationship/child custody issues
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TREATMENT DO'S AND DON'TSTREATMENT DO'S AND DON'TS
DO’SDO’S
Use the proper pronouns based on client’s self-Use the proper pronouns based on client’s self-identity when talking to/about transgender individuals.identity when talking to/about transgender individuals.
Get clinical supervision if they have issues or feelings Get clinical supervision if they have issues or feelings about working with transgender individuals.about working with transgender individuals.
Allow transgender clients to continue the use of Allow transgender clients to continue the use of hormones when they are prescribed. Advocate that hormones when they are prescribed. Advocate that the transgender client using “street” hormones get the transgender client using “street” hormones get immediate medical care and legally prescribed immediate medical care and legally prescribed hormones. hormones.
Take required training on transgender issues.Take required training on transgender issues.
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TREATMENT DO'S AND DON'TSTREATMENT DO'S AND DON'TS
DO’SDO’S
Find out the sexual orientation of all clients. Find out the sexual orientation of all clients.
Allow transgender clients to use bathrooms and Allow transgender clients to use bathrooms and showers based on their gender self-identities and showers based on their gender self-identities and gender roles.gender roles.
Require all clients and staff members to create and Require all clients and staff members to create and maintain a safe environment for all transgender maintain a safe environment for all transgender clients. Post a nondiscrimination policy in the waiting clients. Post a nondiscrimination policy in the waiting room that explicitly includes sexual orientation and room that explicitly includes sexual orientation and gender identitygender identity.
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Prairelands ATTC Toolbox Training Module 5 – 12 Clinician’s Overview
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Don’t call someone who identifies as a female “he or him” or call someone who identifies as male “she or her”.
Don’t project transphobia onto the transgender client or share transphobic comments with other staff members or clients.
Never make the transgender client choose between hormones and treatment and recovery.
Don’t make the transgender client educate the staff. Don’t assume transgender women or men are gay. Don’t make transgender individuals living as females use
male facilities or transgender individuals living as males use female facilities.
Never allow staff members or clients to make transphobic comments or put transgender clients at risk for physical or sexual abuse or harassment.
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TREATMENT DO'S AND DON'TSTREATMENT DO'S AND DON'TS