1. REDEFINING THE STANDARD WITH TRANSGENDER CLINICAL COMPETENCY DiversityRX Conference March 13, 2013 Anand Kalra, Program Manager

2. Agenda 1. Introductions 2. Transgender People & Barriers to Health 3. Project HEALTH approach 4. Questions?

3. Intended Outcome  Increase knowledge about:  Transgender people  Social determinants of health disparities  Successful methods for improving community health

4. Getting to Know Me  Anand Kalra  Project HEALTH Program Manager at the Transgender Law Center  Secret librarian agenda  Transgender man

5. Getting to Know You  Who is new to the world of transgender issues?  Who has received training about transgender issues?  Who has worked with transgender patients?

6. Transgender Law Center works to change law, policy, and attitudes so that all people can live safely, authentically, and free from discrimination regardless of their gender identity or expression.

7. Lyon-Martin Health Services personalized healthcare and support services to women and transgender people who lack access to quality care because of their sexual or gender identity, regardless of their ability to pay.

8. Transgender Communities Common Terms  Gender Identity  A person’s internal, deeply-felt sense of being male, female, something other or in-between.  Gender Expression  An individual’s characteristics and behaviors such as appearance, dress, mannerisms, speech patterns, and social interactions that are perceived as masculine or feminine.  Transgender  An umbrella term that can be used to describe people whose gender expression is nonconforming and/or whose gender identity is different from their birth assigned gender.  Gender non-conforming  A person who has, or is perceived to have, gender characteristics and/or behaviors that do not conform to traditional or societal expectations.

9. What standard are we redefining?  Systemic Barriers  Unemployment and under-employment Transgender Californians are twice as likely to have a Bachelor’s Degree And twice as likely to live under the poverty line Nearly 70% report experiencing discrimination or harassment at work  Lack of Access to Health Care Denial of Private Insurance Exclusions of transition-related and gender-specific care Lack of Educated Providers

10. What standard are we redefining?  Key Findings – Health Care  19% were refused medical care  50% had to “teach my provider” about basic transgender health  28% postponed medical care when sick or injured  Four times the national average for HIV

11. Project HEALTH  Improves access to & quality of transgender health services through:  Clinic Technical Assistance  Student Clinical Rotation  Policy Advocacy  TransLine: Medical Consultation Service  Outreach

12. Clinic Technical Assistance  Buy-in from key administrators and providers  Needs assessment  Training:  Cultural competence  Clinical competence  Legal frameworks  Operations support  EMR  Intake forms  Billing codes  Patient Satisfaction Survey

13. Student Clinical Rotation  Hosted at Lyon-Martin  Practical curriculum  Video lectures  Final Exam  More than 60 MD, NP, PA students trained in 4 years

14. Policy Advocacy  Local:  San Francisco: transition exclusions out of Health San Francisco (public health coverage)  Humboldt County: county-wide trans-inclusive employment nondiscrimination policy  Los Angeles: trans-inclusive nondiscrimination policy in homeless shelters  State:  Department of Insurance (PPOs)  Department of Managed Health Care (HMOs)  Federal:

15.  The National Transgender Medical Consultation Line  offers physicians and health care providers the latest transgender clinical information, and individualize expert case consultation across the broad range of clinical transgender issues.  Staffed by clinicians experienced in transgender medicine who can help provide the best possible care  65 questions answered since launch in September

16. That was a lot of info…  Questions?

17. Thank you! www.project-health.org  Anand Kalra  anand@transgenderlawcenter.org  415-865-0176, ex. 305