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

2. 2 Overview – Working Group Outcomes 1)Increase provincial access to trans* friendly and experienced health care providers (including both primary and emergency care) 2)Increase GP comfort/knowledge/ability in prescribing hormone therapy 3)Create low cost and accessible mental health supports throughout the province

3. 3 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

4. 4 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

5. 5 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.

6. 6 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

7. 7 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

8. 8 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 annual use should not be capped and should be 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.

9. 9 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)

10. 10 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-genderhttp://www.cdha.nshealth.ca/pridehealth/faces-gender

11. 11 3) Create low cost and accessible mental health supports throughout the province Recommendation #9 Increase access to existing psychiatrist, councilor assistance or social workers utilizing technology Implementation: Undertake up-front body of work to develop a model for delivering psychiatrist, counsellor 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

12. 12 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)

13. 13 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 Resolve gaps in the current state: –Currently youth anywhere in BC (under 25) can access VCH for publically funded assessments –Currently only adults in VCH can get publically funded assessments –Currently if outside of VCH, adults in most circumstances will have to pay for assessments themselves Link to Surgery WG

14. Interrelationships 1. THiP as centralized resource2. Specialized team 3. Utilize technology for hormone assessments 4. How to be an educated health care consumer 5. Demystify trans* with health care providers 6. New GP billing code7. Speciality GP to family GP process 8. Awareness for MOAs & front desk/reception staff 9. Utilize technology to increase access to existing mental health providers 10. ‘What q’s to ask’ for health care providers 11. Publically funded assessments Community Support WG Surgery WG RACE line Deliver through 14 Community Support WG Education WG

15. 15 Complexity and Impact Matrix Ease of Implementation EASY HARD Impact of change. LOW HIGH 1 4 9 2 THiP as centralized resource (S) Specialized team (S) Utilize technology (S) 11 Publically funded assessments (S) How to be an educated health care consumer (S) 5 Demystify trans* (S) 6 New GP billing code (S) 7 Speciality GP to GP process (S) 8 Awareness for MOAs & front desk/ reception staff (S) 10 What q’s to ask for health care providers (S) 3 3 Utilize technology for assessments (S) Trans* health standard part of primary care (L)