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<Title><![CDATA[Transgender 101]]></Title>
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<SlideText><![CDATA[Increasing  Gender Competence  and  Cultural Humility   ]]></SlideText>
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<SlideText><![CDATA[Barbara Garcia, MPA Director of Health San Francisco Department of Public Health  [Click to Read Barbara’s Address]  ]]></SlideText>
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<SlideText><![CDATA[Barbara Garcia, MPA Director of Health San Francisco Department of Public Health  [Read Barbara’s Address]  Hi.   This is Barbara Garcia, Director of Health. As you know DPH is committed to providing relevant, sensitive and competent services throughout our systems of care. We want to welcome transgender patients and clients and provide the highest quality of care we can offer. We recognize that transgender, transsexual and gender nonconforming patients are at risk for health-related problems, for violence and for mental health concerns due to the stigma and discrimination that they are faced with in our communities. As healer and helpers we want to provide informed and relevant care. This training is a step to improve the experience of transgender, transsexual and gender nonconforming patients in our hospitals and clinics. Close ]]></SlideText>
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<Title><![CDATA[Objectives]]></Title>
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<SlideText><![CDATA[Course Objectives  This course will help to ensure that all DPH services comply with the following ideals when serving transgender, transsexual and gender non-conforming patients:  Staff are always welcoming and respectful.  Staff are comfortable and sensitive when providing care.  Staff understand and comply with all relevant laws as well as DPH policies when providing care.  ]]></SlideText>
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<Title><![CDATA[Genderbread person]]></Title>
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<SlideText><![CDATA[Genderbread person Sex is anatomy. Gender is brain, soul, spirit. Gender expression is how we dress, behave,  clothing, mannerisms,  etc. Orientation is who we love or who we are sexual with. Tying it all together. ]]></SlideText>
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<SlideText><![CDATA[Discrimination ]]></SlideText>
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<SlideText><![CDATA[Outcomes of Healthcare Discrimination  Patients will not disclose that they are transgender if they feel unsafe.  As a result an accurate diagnosis and treatment can be compromised.   Doctors won’t offer pap screens if they don’t know a person has a cervix or prostate exams if they don’t know a person has a prostate.  Patients won’t have access to other services clinics offer such as case management for immigration, housing, insurance etc.  ]]></SlideText>
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<SlideText><![CDATA[97% reported harassment, mistreatment or discrimination at work.   22% reported harassment by the police. 6% were physically assaulted.   53% report being verbally harassed or disrespected in a public setting.    57% experienced rejection by their families.   11% evicted due to gender. Transgender people of color report even greater incidences of harassment and discrimination, particularly African Americans. Transgender people are over-represented in prison. 59 % of incarcerated male-to-female prisoners were sexually assaulted.  Discrimination ]]></SlideText>
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<SlideText><![CDATA[The national average is only 1.6% 41% of Transgender individuals have attempted suicide.  ]]></SlideText>
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<SlideText><![CDATA[For transgender people life can be very difficult.    Sources of resiliency and rebuilding self-esteem such as family, work and friendship can be unavailable for many transgender people.   Transgender people of color report an even greater incidence of harassment, discrimination and poverty.    People come to San Francisco to escape violence and oppression and hope to find acceptance.  Yet they often encounter discrimination and poverty.   ]]></SlideText>
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<SlideText><![CDATA[In 2006 nearly 60% of Transgender people living in San Francisco earned less then $15,300 annually! During the same year the per capita income for all of San Francisco was $45,478 ]]></SlideText>
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<SlideText><![CDATA[Poverty in the Transgender Community Census Respondents 2007 US Census All Multi-Racial Latino Black Transgender Respondents National Center for Transgender Equality ]]></SlideText>
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<SlideText><![CDATA[…imagine visiting your doctor’s  office and having them refuse to use your name! Health care staff routinely refused to use the names and pronouns that patients requested. ]]></SlideText>
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<SlideText><![CDATA[51.9 % of Transgender individuals expect to be  refused health care (Lambda Legal).  ]]></SlideText>
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<SlideText><![CDATA[Health Care Access 19% - 26.7% had been refused medical care (NCTE; Lambda Legal).     28% report harassment in medical settings (Lambda Legal).    20.9% report healthcare providers used harsh or abusive language (Lambda Legal).    7.8% report health care professionals were abusive or physically rough (Lambda Legal).    2% reported violence in the doctor’s office. References: National Center for Transgender Equality Lambda Legal Fact Sheets “Injustice at Every Turn:   A Report of the National Transgender Discrimination Survey,”   National Center for Transgender Equality and the National Gay and Lesbian Task Force. When Health Care Isn't Caring:  Lambda Legal,  Survey on Discrimination Against LGBT People and People Living with HIV ]]></SlideText>
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<SlideText><![CDATA[…but these kinds of things never happen in San Francisco! ]]></SlideText>
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<SlideText><![CDATA[“We Have a Hard Time Treating Your Kind Here”  What transgender women have been told when seeking care at San Francisco based health clinics.  Leah B. Rorvig, M.Sc.   2012 ]]></SlideText>
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<SlideText><![CDATA[Providing Services ]]></SlideText>
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<SlideText><![CDATA[ Our personal beliefs may affect how we care for our patients and clients.  All clients should be treated with dignity and respect.   ]]></SlideText>
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<SlideText><![CDATA[Be Welcoming  Remember, your patient may have been harassed on the way in or, the last time they saw a medical provider, they may have faced discrimination.  It may have taken a lot of courage or desperation for them to come in for help.  Our behavior can create a positive experience for a client and can determine their future use of health care. Remember we can re-traumatize people.  A smile can go a long way to helping someone feel welcome.  And, always use the patient or client’s appropriate pronoun and name.  ]]></SlideText>
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<SlideText><![CDATA[Assumptions create problems, remember  You can’t tell a person’s gender or biological sex from how they appear, from their clothing or their name. You can’t tell a person’s gender from the procedure they are there for.  If you didn’t hear a person’s name, don’t guess, ask again.  Often names have a gender.   Each person is an individual and gender identity is only part of who a person is.  They are artists, musicians, writers, children, parents, etc.  Don’t assume a transgender person wants to be in a program for transgender people.  ]]></SlideText>
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<SlideText><![CDATA[Systems Problems  Our Medical Record and Billing systems may not be welcoming. Forms may ask for birth name or only legal names. Charts may require legal or Medi-cal name.  A patient may have a different preferred name than their legal name which might be different than their Medi-Cal name.  It is complicated and expensive  to change ones name.    What you can do:  Create a system where you will use the patient’s preferred name and appropriate pronoun and ensure that this information is passed along to other caregivers.  Acknowledge the problem, explain it’s a state regulation and how the information is used.   ]]></SlideText>
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<SlideText><![CDATA[Privacy and Safety  Many transgender people are not “out.”  When a transgender person tells you of their transgender status, they are entrusting you with protected health information.  “Outing” is disclosing protected health information and a violation of HIPAA.  You could be putting them at risk.   While you may be a safe person, someone who overhears may be dangerous for a transgender person.     ]]></SlideText>
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<SlideText><![CDATA[You’re trying to be helpful but…  your client is guarded, distrustful,  or even hostile.  Remember   You don’t know what happened to client in the past.  Maybe they were one of the 2% assaulted in a physician’s office.  Perhaps they had providers intentionally use the wrong name to humiliate them. It may be self-protective.  You don’t know what happened to them on the way  in to see you today.  If you make a mistake about a pronoun, apologize and move on. Repair any harm you caused but be careful not to expect the transgender person to take care of you.  If you repeat the mistake, think about what is the barrier for you and get support.    ]]></SlideText>
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<SlideText><![CDATA[Equality in Clinics  Transgender people should be allowed to participate in women and/or men’s groups appropriate to their identity.  Transgender, transsexual and gender non-conforming people have the right to use whatever bathroom they choose.   2002 SF HRC report 50% of transgender people had been harassed or assaulted in public bathrooms.  Many people will go all day without using a bathroom to avoid the possibility of being harassed.   There are people whose gender may change from visit to visit. They should be allowed to use the bathroom of their choice. ]]></SlideText>
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<Title><![CDATA[Additional Resources]]></Title>
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<SlideText><![CDATA[General Information   Understanding Transgender People FAQ: Intersex Society of North America National Center for Transgender Equality Reports   Mental Health Resources Report of the Task Force On Gender Identity and Gender Variance: Gender Diagnoses in the DSM-5 Practical Tips for Working With Transgender Survivors of Sexual Violence   Medical Health Resources Medical Therapy and Health Maintenance for Transgender Men:  A Guide For Health Care Providers Dimension Clinic Hormone Therapy Information Our Bodies Ourselves - Intersex Web Links Tom Waddell Hormone Protocol  Multi-Disciplinary Resource Centers Center of Excellence for Transgender Health Vancouver Coastal Health   Local San Francisco Transgender Resource Manual Dimensions LGBTQIQ Bay Area Resource Guide: “Little Black Book” San Francisco Trans March    Legal National Center for Lesbian Rights Transgender Law Center Transgender and Gender Diverse Resources ]]></SlideText>
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<Title><![CDATA[Thank You]]></Title>
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<SlideText><![CDATA[Thank You For Completing this Course  Please feel free to contact any of the below listed  members of the Gender Competency Committee for more information:  Maria Porch Dan Karasic  Heather Weisbrod Julie Graham Robyn Stukalin Amber Gray Kandi Patterson Conrad Wenzel ]]></SlideText>
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