Research

  • Transgender and Nonbinary Individuals’ Experiences in Healthcare

    Transgender and gender non-conforming (TGNC) individuals utilize mental health services at a high rate relative to the general population (Grant et al., 2011; Green et al., 2013; Wang et al., 2005); however, studies have found that the quality of care that they receive is often lacking (Benson, 2013; Whitman & Han, 2017). Clinicians are often uninformed about TGNC issues (Benson, 2013; Whitman & Han, 2017) resulting in clients needing to educate their therapist (Benson, 2013; Elder, 2016). Additionally, a lack of information may lead otherwise well-meaning clinicians to perpetuate microaggressions against their TGNC clients. Microaggressions are subtle, often implicit forms of discrimination that convey a negative attitude towards a minority person’s identity (Sue et al., 2007). While microaggressions against TGNC individuals have not yet been examined in a therapeutic context, previous work has examined TGNC microaggressions in everyday life (Nadal, Skolnik, & Wong, 2012) and in the context of friendship (Galupo, Henise, & Davis, 2014). Additionally, one study examined the microaggressions faced by sexual minority clients in therapy (Shelton & Delgado-Romero, 2013); due to the close relationship between these communities (sexual and gender minorities), these microaggressions may extend to TGNC clients as well. Microaggressions can impact the relationship between the aggressor and target (Galupo et al., 2014), a concern given the importance of the therapeutic alliance on therapy outcomes (Baldwin, Wampold, & Imel, 2007; Martin, Garske, & Davis, 2000). With racial minority clients, the presence of microaggressions in therapy has been linked with weaker therapeutic alliance (Constantine, 2007; Macdonald, 2013; Neville, Spanierman, & Doan, 2006; Owen et al., 2011), poorer therapeutic outcomes (Constantine, 2007; Owen et al., 2011), and may lead to early termination (Owen et al., 2017). Understanding what constitutes a microaggression in this context may be a necessary step for therapists to engage in fewer microaggressions and resolve those that do occur (Owen et al., 2018; Owen, Tao, Imel, Wampold, & Rodolfa, 2014). Although there has been growing interest in ensuring that TGNC clients receive culturally competent mental health services (American Psychological Association, 2015; Boroughs et al., 2015; Elder, 2016; Hendricks & Testa, 2012; Singh, 2016), many clinicians fall short of providing this (Benson, 2013; Elder, 2016; Whitman & Han, 2017). In order to provide a more affirming and effective therapy experience for TGNC clients, more needs to be known about their experiences in psychotherapy. Much of the research that exists on the topic has focused on general experiences and relied on small sample sizes (Benson, 2013; Elder, 2016).The present study aims to begin to fill this gap by qualitatively exploring the experiences of TGNC clients with microaggressions in therapy. Thus, analysis of the data collected from this study will aim to investigate the following research questions: 1) What types of microaggressions do TGNC clients face in therapy and how do these microaggressions manifest? 2) How do TGNC clients react to or cope with microaggressions in this context? 3) What factors do TGNC clients value when working with mental health professionals?

  • Building Better Support for Trans Youth during COVID and Beyond

    This project is an extension of study supported by a Ryerson Internal FCS SEED grant that seeks to identify best practices for supporting young trans and gender diverse young people in healthcare, education, and social services. A fifteen-person trans youth advisory committee representing multiple gender identities, ethno-racial backgrounds, and geographical locations was convened. This committee wanted to hear from trans youth about their needs and experiences and they wanted to have a snapshot of the training, policies, and practices service providers already engage in. As a result, two surveys were constructed, one to gather input from young trans people and another for service providers. Recruitment took place in late 2019 with over 200 respondents from each province and territory in Canada participating. A second recruitment wave was being planned as the global pandemic unfolded and the trans youth advisory committee was reconvened. The committee strongly feels that objectives of the above-study are even more important in the context of COVID-19 and is concerned about the impact the pandemic is having on gender diverse youth. As a result, both surveys were modified to capture this impact, current service provider needs, and any unfolding COVID-19-specific policies and practices. Four trans youth research assistants have been hired and REB approval for these modifications has been received. The outputs of this data will be 1) A series of one-page public reports, 2) Informing the Mental Health Commission of Canada’s COVID-19 policy document, 3) Informing a Partnership Development Grant, and 4) Journal manuscripts.

  • Precarious Inclusion: Studying Ontarian LGBTQ+ parents’ experiences childrearing in a post-legal parity framework

    A team of LGBTQ+ parents and researchers at the University of Guelph are conducting a study to learn more about what it is like to raise a child in this time of political backlash and equal legal LGBTQ+ parenting rights. We would like to know how other forms of discrimination impact your experiences as an LGBTQ+ parent. We also want to learn how your experiences as an LGBTQ+ parent influence how you care for and protect your children. Study results will lead to new knowledge about how LGBTQ+ discrimination exists in the current political climate and lead to improved LGBTQ+ inclusion. Background Rationale: It is a unique and complex time to be a LGBTQ+ family in Ontario. In the past 15 years key laws and policies have changed to become less discriminatory towards LGBTQ+ families: the Equal Marriage Act, passed; “gender dysphoria” clinics closed; gay conversion therapy, banned; and funding approved for trans-related surgeries. The last hurdle for legal LGBTQ+ family equality was reached in 2016 when a group of parents successfully won a charter challenge case against the Ontario Liberal government for discriminating against LGBTQ+ families. With this victory came the All Families Are Equal Act, where parental rights were awarded based on intention rather than biology and gender neutral language was incorporated into standardized documents and family law. While achieving legal recognition, existing research shows that LGBTQ+ parents still face significant barriers when accessing social institutions (government, education, healthcare, recreation). Debates in the policy sphere reveal that LGBTQ+ families continue to experience precarious inclusion. The Ontario Progressive Conservative (PC) government’s recent scrapping of the Liberal government’s LGBTQ+-inclusive sexual education curriculum is one poignant example. The recent passing and then retracting of the resolution to debate if gender identity is “a liberal ideology” at the PC convention, is another. On the level of routine social interaction current literature indicates that heterosexual dominance continues to inflect the daily lives of LGBTQ+ families. There has yet to be a study of how this profound cultural ambivalence shapes the lives and wellbeing of LGBTQ+ families. Objectives: The aim of this study is to explore inequities that surface in the gaps between law and policy and practice to identify opportunities for restructuring. We plan to: 1) Understand LGBTQ+ parents’ current experiences of inclusion and exclusion when navigating legal, institutional (government, healthcare, education, recreational) and social interactions in everyday life; 2) Examine how intersecting identities with regards to sexuality, gender, geography, disability, class, race, Indigeneity, and ethnicity influence LGBTQ+ parents’ experiences of inclusion and exclusion; 3) Explore how experiences of inclusion/exclusion influence LGBTQ+ parents’ values, philosophies and strategies for protecting and caring for their children to create familial belonging. To learn about everyday LGBTQ+ parenting experiences, interviews for this study will focus on learning LGBTQ+ parents’ everyday experiences when: • Accessing childcare and education programs • Encountering the law and/or police • Participating in community, religious, political, cultural events or groups • Accessing drop-in centers and recreational services • Accessing reproductive services or healthcare for your child • Accessing social services, Newcomer programs, language services • Participating in parenting groups or communities • Encountering strangers, acquaintances, neighbors, family members and friends • Completing forms like Declaration of Parentage, your child’s Birth Certificate, Health Card, and Passport. Our participants will comprise 30 LGBTQ+ families who will complete a 1-1.5 hour long anonymous and confidential semi-structured interview completed in their home or a place of business in their area. Download the recruitment poster.

  • Begin Exploring Fertility Options, Risks and Expectations (BEFORE): Canadian e-health apps for shared decision-making with people at risk of cancer treatment

    Our team is currently working on a study aimed at improving the quality of fertility decision-making for young cancer patients in Canada. Some cancer treatments can cause infertility in survivorship and currently patients feel as though they do not have sufficient information to make decisions on preserving their fertility before treatment or information on parenthood options after treatment. Through this study we are in the process of creating mobile apps that will provide information and help young cancer patients make fertility related decisions before or after they have treatment. It is our intention that this tool is inclusive and supports a diverse Canadian population.

  • An Examination of Resilience Against HIV/AIDS Among Middle-aged and Older Men Who Have Sex With Men: Resources, Strengths, and Protective Factors

    Background and Rationale: There is considerable resilience among middle-aged and older, cis and trans, gay, bisexual, and other men who have sex with men (MSM) against HIV/AIDS. Despite being part of a population at increased risk for acquiring HIV, many MSM aged 40 years and older (40+) have remained HIV-negative (HIV-) since the start of the epidemic. Among HIV-positive (HIV+) MSM aged 40 years and older, many have exhibited resilience against HIV/AIDS not only by surviving its adverse impacts, but also by living active and full lives; fiercely advocating for their rights, and health care and service needs; and staunchly supporting and promoting prevention and intervention programs dedicated to ending HIV/AIDS. Since the beginning of the HIV/AIDS epidemic in the early 1980s, MSM have remained the population most affected by HIV/AIDS in Canada. Although the proportion of HIV cases among MSM 30 to 39 years old has been decreasing since 1994, the proportion of new HIV infections among 40+ MSM has been increasing since the beginning of the epidemic. The Public Health Agency of Canada reports that most research available on HIV/AIDS among MSM focuses on their vulnerability and that research on resilience of MSM against HIV/AIDS is wanting. It also reports that although there are studies on young MSM and resilience, there is a lack of research undertaken with older MSM. This suggests that resilience of older MSM against HIV/AIDS represents a serious research gap. Scientific literature and historical accounts provide evidence of resilience among MSM, and some research shows the challenges and coping strategies of HIV+ older MSM. However, to date, there has been no research conducted to examine the resilience of both HIV+ and HIV- 40+ cis and trans MSM against HIV/AIDS. Aim: The aim of our project is to examine the resources, strengths, and protective factors HIV+/- 40+ MSM possess that prevent HIV acquisition and transmission in the community and allow them to thrive in a society that may not be ready to meet the growing needs of a burgeoning number of older MSM and HIV long-term survivors in the decades to come. Project Design: Staying true to the tenets of Community-Based Research (CBR), we plan to recruit and include in our project several HIV+ and HIV- 40+ MSM as members of our Community Advisory Board and as peer researchers (PRs) so that they can provide input and feedback on all aspects and during all stages of the research process as full partners. We will provide training for our PRs so that they can interview thirty HIV+ and thirty HIV- 40+ cis/trans MSM from across Ontario to explore their resilience against HIV/AIDS. Our PRs will use an interview guide – informed, developed, and created with the input of our relevant stakeholders – to conduct confidential, semi-structured, digitally audio-recorded interviews with study participants. We will be employing a constructivist grounded theory approach to our research project, including multiple perspectives and interpretations into the iterative process of generating information and theory from the critical thematic analysis of interview data at different phases of the project.