March 14, 2018
A new report from UBC’s Stigma and Resilience Among Vulnerable Youth Centre (SARAVYC) shows a snapshot in time of trans people’s experiences with transition-related surgeries (TRS) in Ontario. The Ontario analysis was funded by the partners in Ontario’s Trans Health Expansion (THEx): Sherbourne Health including Rainbow Health Ontario, Women’s College Hospital and the Centre for Addiction and Mental Health.
According to Dr. Elizabeth Saewyc, senior author of the report, “The survey offers a national and Ontario-focused overview of transition-related surgical experiences in Canada. The report adds to our information on how gender-affirming care is delivered, and important aspects of how people navigate and experience surgeries and assessments.”
The report, A Survey of Experiences with Surgery Readiness Assessment and Gender-Affirming Surgery Among Trans People Living in Ontario, predominantly captures experiences that took place before Ontario’s 2016 regulation changes for TRS referrals, establishing invaluable baseline data for any future evaluations that may focus on post-reform experiences.
“We’re pleased to see that many of the report’s recommendations align closely with the work in progress by the partnership, including increasing trans competence training for providers, improving options for surgeries closer to home, boosting aftercare supports, and creating clarity around surgical processes,” says Devon MacFarlane, Director, Rainbow Health Ontario, a program of Sherbourne Health, speaking on behalf of the THEx. “This report validates some of the steps we’ve taken already, and also highlights how much more needs to be done across the system to ensure a consistent, accessible experience for anyone in Ontario seeking TRS. Particularly striking is the effect of having to travel more than two hours for TRS, both in terms of the out-of-pocket costs to individuals and the potential for increased incidence of post-surgical complications.
Since the 2016 regulation change that allowed primary care providers in Ontario to offer TRS assessments and referrals, the THEx has been hard at work to improve access to TRS and post-surgical care across the province. To date, the partnership has:
- Cleared the Centre for Addition and Mental Health’s pre-regulation change legacy waitlist of 1600 assessments for both funding approval and for TRS, and has reduced the wait time for new clients of theirs by over 50%;
- Boosted capacity in Sherbourne Health’s ARC (Acute Respite Care) short-term, post-surgical recovery program to provide care following TRS—a service accessed by 27 clients to date;
- Through Rainbow Health Ontario, developed and delivered training curricula for service providers to increase comfort and clinical competency for providing referrals—327 providers in 11 LHINs have so far received this training;
- Taken key steps to build a TRS surgical program at Women’s College Hospital including the development of a community-informed Model of Care and acquisition of surgical expertise; and
- Collaborated with stakeholders and community members to develop a resource to help navigate the TRS funding approval process, the Transition-Related Surgeries FAQ.
The THEx partners continue to implement their various mandated trans health access reforms while advising the Government of Ontario on policy and systems gaps still to be addressed.
Communications Coordinator, Rainbow Health Ontario,
a program of Sherbourne Health
The report found that:
- “…While 12% of respondents identified as non-binary (as compared to transmasculine or transfeminine), in a separate question they were asked to write in their gender identity and the large number of different responses suggests that more complex understandings of gender are needed throughout the surgery process, especially non-binary genders identities.”
- “Over half (57%) of respondents in ON had to travel over 2 hours to have surgery. While this is not surprising, as many surgeries are not performed in ON, many of the written comments recommended limiting travel and the associated costs as key measures to improve the experience.”
The report recommended:
- “Increase trans competence trainings for assessors to ensure a greater number of trans-competent local primary care providers.”
- “Emphasize a patient-centered, informed consent model that would ensure people have all the information they need to make the best decision for themselves.”