Transgender/Trans* Health Primary & Emergency Care Access / Consulting Working Group

Overview – Working Group Outcomes Increase provincial access to trans* friendly and experienced health care providers (including both primary and emergency care) Increase GP comfort/knowledge/ability in prescribing hormone therapy Create low cost and accessible mental health supports throughout the province

1) Increase provincial access to trans 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

1) Increase provincial access to trans 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

1) Increase provincial access to trans 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.

1) Increase provincial access to trans 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

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  Process - (e.g. identify messages, create marketing materials, identify and leverage the existing GP marketing/communications etc.). Mental Health support - Some GPs would be comfortable to deliver this support themselves; some will want mental health support for the patient.

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 should not be capped and is traditionally in 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.

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)

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

3) Create low cost and accessible mental health supports throughout the province Recommendation #9 Increase access to existing psychiatrist, counsellor assistance or social workers utilizing technology Implementation: Undertake up-front body of work to develop a model for delivering psychiatrist, councilor 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 Model to include: i) understanding of supply and demand; ii) review of how technology is being utilized (specifically in wider MH services); iii) guidelines / how-to utilize technology; iv) relevant privacy/policies to ensure safe care; v) different technologies to be used between adult & youth services

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)

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 Youth anywhere in BC (under 25) can access VCH for publically funded assessments. Only adult in VCH can get publically funded assessments. If outside of VCH, adults in most circumstances will have to pay for assessments themselves. Link to Surgery WG

Interrelationships 1. THiP as centralized resource 6. New GP billing code RACE line Community Support WG Education WG 2. Specialized team 7. Speciality GP to family GP process 3. Utilize technology for hormone assessments 8. Awareness for MOAs & front desk/reception staff Community Support WG Deliver through Community Support WG 4. How to be an educated health care consumer 9. Utilize technology to increase access to existing mental health providers 10. ‘What q’s to ask’ for health care providers RACE line 5. Demystify trans* with health care providers Surgery WG 11. Publically funded assessments

Complexity and Impact Matrix THiP as centralized resource (S) New GP billing code (S) EASY 6 7 Speciality GP to GP process (S) 1 9 Utilize technology (S) What q’s to ask for health care providers (S) 10 5 Demystify trans* (S) 8 Awareness for MOAs & front desk/ reception staff (S) Ease of Implementation 3 Utilize technology for assessments (S) 2 Specialized team (S) 4 How to be an educated health care consumer (S) 11 Publically funded assessments (S) Trans* health standard part of primary care (L) HARD 3 LOW Impact of change. HIGH