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<Title><![CDATA[Transgender 101]]></Title>
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<Title><![CDATA[Increasing Gender Competence and Cultural Humility ]]></Title>
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<SlideText><![CDATA[Increasing  Gender Competence  and  Cultural Humility   ]]></SlideText>
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<SlideText><![CDATA[Barbara Garcia, MPA Welcome from the Director of Health ]]></SlideText>
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<SlideText><![CDATA[Course Objectives  This course will help to ensure that all DPH services for transgender, transsexual and gender non-conforming patients comply with the following ideals:  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[Important Terms to Know and Understand]]></Title>
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<SlideText><![CDATA[51.9 % of transgendered individuals expect to be  refused health care.  ]]></SlideText>
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<Title><![CDATA[Health Care Access]]></Title>
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<SlideText><![CDATA[Health Care Access 19% - 26.7% had been refused medical care.     28% report harassment in medical settings.    20.9% report healthcare providers used harsh or abusive language.    7.8% report health care professionals were abusive or physically rough.    2% reported violence in the doctor’s office.  “Injustice at Every Turn”, A Report of the National Transgender Discrimination Survey National Center for  Transgender Equality  Lambda Legal Fact Sheets References: ]]></SlideText>
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<Title><![CDATA[…imagine visiting your doctor’s  office and having them refuse to use your name!]]></Title>
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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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<Title><![CDATA[Outcomes of Healthcare Discrimination]]></Title>
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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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<Title><![CDATA[Stereotypes that Interfere with Care]]></Title>
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<SlideText><![CDATA[Stereotypes that Interfere with Care Transgender people have HIV. Transgender people are sex workers. Transgender people are mentally ill. Transgender people are addicts, drug seeking. Transgender women are “Drama queens.” Transgender people are uneducated and unemployed.  ]]></SlideText>
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<Title><![CDATA[Discrimination]]></Title>
<Notes><![CDATA[l]]></Notes>
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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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<Title><![CDATA[Extreme Outcomes of Discrimination]]></Title>
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<SlideText><![CDATA[The national average is only 1.6% 41% of transgendered individuals have attempted suicide.  ]]></SlideText>
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<SlideText><![CDATA[…but these kinds of things never happen in San Francisco! ]]></SlideText>
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<Title><![CDATA[“We Have a Hard Time Treating Your Kind Here”What one transgender women was told when seeking care at a San Francisco based health clinic.Leah B. Rorvig, M.Sc.   2012]]></Title>
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<SlideText><![CDATA[“We Have a Hard Time Treating Your Kind Here”  What one transgender women was told when seeking care at a San Francisco based health clinic.  Leah B. Rorvig, M.Sc.   2012 ]]></SlideText>
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<SlideText><![CDATA[In 2006 nearly 60% of transgendered people living in San Francisco  earned less then $15,300 annually! ]]></SlideText>
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<Title><![CDATA[Poverty in the Transgender Community2007 U.S. Census]]></Title>
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<SlideText><![CDATA[Poverty in the Transgender Community 2007 U.S. Census All Respondents All Multi-Racial Latino Black Transgendered Respondents ]]></SlideText>
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<SlideText><![CDATA[For transgendered 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 immigrate 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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<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, x Orientation is who we love or who we are sexual with. Trying it all together. ]]></SlideText>
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<Title><![CDATA[Want to help make a difference?]]></Title>
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<SlideText><![CDATA[Want to help make a  difference? ]]></SlideText>
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<SlideText><![CDATA[ Our personal beliefs may effect how we care for our patients and clients.  All clients should be treated with dignity and respect.   ]]></SlideText>
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<SlideText><![CDATA[When a client or patient arrives remember   Be welcoming.  It might feel like going an extra mile but remember that 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 some people to come in for help.  Our behavior can influence how that person will use health care in the future. Remember we can re-traumatize people.  A smile can go a long way to helping someone feel welcome.  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.  (Transwomen have prostates.) 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 requirements 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 to change ones name.  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  Transgendered 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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<SlideText><![CDATA[Thank You For Completing this Course  For more information please visit us on the web or contact.  ]]></SlideText>
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