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Improving transgender-spectrum health education for mental health professionals: Development of the Trans Health Educational Tool

Researcher bios and how their research backgrounds relate to this study

Sofia Melendez’s work broadly focuses on enhancing mental health services and higher education systems to be more welcoming towards gender and sexual diversity. Currently, Sofia is completing a Master of Education at Queen's University where she is researching how to improve the education that mental health professionals receive about transgender-spectrum (trans) health. She has a background in psychology (B.Sc.H from Queen's University) and will begin her clinical psychology training at Ryerson University in the Fall of 2021. Thanks to her exposure to the research fields of psychology, education, and gender, she has the capacity to apply the strengths of diverse epistemological traditions that enable her to support diverse and marginalized communities through her research. As a queer Mexican-Canadian Mestiza woman and an uninvited first-generation settler on the lands of the Haudenosaunee and Anishinaabe, Sofia leads and supports projects that are gender-transformative, anti-oppressive, and collaborative. She draws from critical pedagogy, intersectionality, and decolonial approaches in her work.

Purpose of this research project

Context. Across North America, mental health professionals and trainees are ill-equipped to work with transgender-spectrum (trans) communities (Heng et al., 2018; McCann & Sharek, 2016; O’Hara et al., 2013). Many mental health professionals report having had little or no education about how to care for trans clients, and only one in three clinical psychologists self-report having the clinical competency to treat trans clients (Johnson & Federman, 2014; Lutz, 2013; Ryu, 2018). They report lacking the education necessary to develop trans health knowledge, skills, and reflexivity (KSR; Hodgins et al., 2020; Johnson & Federman, 2014).

Purpose. The aim of this study is to develop a tool that tests and supports trans health education for mental health professionals. The tool contains clinical situations with (1) multiple-choice questions to test the knowledge, skills, and reflexivity of mental health professionals (Lievens et al., 2008) and (2) educational feedback about the situation. We hope this tool can be used in clinical courses, self-assessments, and research.

Method. Experts in trans mental health will be invited to provide feedback on the tool’s situations, questions, and educational materials through two to three online surveys (modified Delphi survey technique; Hasson, 2008). Experts include transgender, nonbinary, gender fluid, genderqueer, Indigiqueer, & Two-Spirit peoples with intersecting backgrounds, as well as trans-affirmative mental health professionals, psychometrics experts, and education specialists. Thematic analyses will look to find themes for each cycle of feedback. This research is part of Sofia’s Master of Education program.

Impact. Through the development of this tool, trans voices will steer the transformation of mental health training. The tool may promote social accountability in mental health professionals who may be in a better position to support trans people.

How this research will help LGBT2SQ people and communities

The aim of this study is to develop a tool that tests and supports trans-spectrum health education for mental health professionals. Through the development of this tool, trans voices will steer the transformation of mental health training. The tool may promote social accountability in mental health professionals who may be in a better position to support trans people. This is an important area of focus because it is projected that most mental health professionals are likely to encounter trans clients as the trans community continues to grow and seek mental health services in increasing numbers (APA, 2015; Chen, Fuqua, & Eugster, 2016; Goodman et al., 2019). Further, there is an association between having a health professional that is perceived by trans clients to be inclusive of and respectful toward transgender communities, and decreased rates of depression and suicidal ideation, as well as improved mental well-being in trans people (Kattari et al., 2016).

Participants

Eligibility. For this research, we are seeking people who have any of the following social positions and/or identities:

• Transgender, gender non-conforming, gender non-binary, gender diverse, genderqueer, Two-Spirit, Indigiqueer, and/or having a gender identity that differs from the social expectations of the sex you were assigned at birth.
• Mental health professionals experienced in affirmative transgender healthcare and involved in therapy (i.e., social worker, clinical psychologist, couples and family therapist, family physician, psychiatrist).
• A representative of a trans-affirmative mental health organization.
• An expert in psychometrics.
• An education specialist.

Compensation

Participants have a chance to win one of two $100 prizes. This money can also be donated to Trans Lifeline, a trans-led support organization.

Additionally, this research is anonymous and confidential, but if participants are interested, they can request to be identified as a contributor to the development of this trans health educational tool and become more involved with the research processes they are interested in (i.e., publication, knowledge translation). This is in alignment with the self-voicing principle where research goes beyond ‘inclusion’ and ‘engagement;’ communities construct and author their knowledge and define their own actions.

Mitigation measures

There is a possible emotional risk for participants who are trans, nonbinary, genderqueer, or those who know transgender people. The Trans Health Educational Tool outlines several situations about transgender-spectrum (trans) clients undergoing challenges within the healthcare system. These situations contain sensitive subjects that may be distressing for some participants.

To reduce potential distress, we have included the following:
1) The letter of information and instructions will contain content warnings that notify participants that the situations in the instrument may be potentially sensitive content related to transgender healthcare.

2) The educational feedback on the Trans Health Educational Tool is strengths-based, intersectional, and anti-oppressive to promote transgender affirmative healthcare responses.

3)Trans-affirmative support resources will be provided at the end of the instrument in-case participants need to debrief or support.

Further, the instructions outline the limitations around representation "Trans and gender diverse communities are made up of people with diverse experiences, intersecting identities, and unique journeys. The situations in this instrument highlight some lived experiences and trans-related topics, but it is essential to recognize that no one situation can represent all trans peoples' experiences."

Finally, because the researchers are cisgender we include the following statement in the letter of information and attach it to promotional materials: "Transparency and commitment: I like to share with my collaborators that I am cisgender and recognize the need to have trans-spectrum people self-voicing and leading this work. I do not want to take up space, so I am here to facilitate and support the push towards gender-transformative impacts in mental health training. If you are transgender, nonbinary, genderqueer, genderfluid, agender, Indigiqueer, and/or Two-Spirit, I want your voice steering this work!"

Promoting the Study

The primary means of promotion is by posting on social media (i.e., Twitter, Facebook, Instagram, Reddit, etc.) I am also connecting with known trans-spectrum (trans) health advocates, organizations that support trans health, and trans-affirmative mental health professionals through email to invite them to participate. I have also advertised the study on my website (https://sofiamelendezron.wixsite.com/transed).

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