Assessment of Transgender/Gender-Expansive Accessibility in Inpatient Pediatric Mental Health Facilities

Purpose

This study surveyed a national sample of inpatient pediatric behavioral health facilities on policies related to care for transgender and gender-expansive (TGE) youth to assess adherence to best practices.

Methods

Staff/providers at youth inpatient psychiatric facilities were recruited by phone or email. Participants completed an electronic survey on facilities' training policies, staff comfort related to gender diversity, and other policies related to caring for TGE youth.

Results

Of 479 potential participating facilities, 124 surveys were initiated and 59 were completed. Measures to ensure accessibility to TGE patients are present in many facilities surveyed, with most reporting that their facility had nondiscrimination policies in place (86.2%) and required training on working with TGE patients (52.5%). A minority of participants (12.1%) reported that their facility roomed TGE youth based on sex assigned at birth, although only a small portion roomed based on gender identity alone (19.0%). Slightly more than two-thirds stated that their facility had individual restrooms available. Most participants (74.6%) stated that facility staff were comfortable discussing gender diversity in general, although this was less common for other topics related to TGE patient care.

Conclusion

Our survey highlights efforts made by inpatient behavioral health facilities to ensure accessibility of services to TGE youth, although our results showed notable differences across facilities. Given inconsistent federal protections for TGE patients, there remains a need for efforts to ensure that TGE youth are receiving all possible support in these treatment settings, such as accessible restrooms and bedroom assignments, as well as the opportunity to room with peers.

Collaborating with transgender youth to educate healthcare trainees and professionals: randomized controlled trial of a didactic enhanced by brief videos

BACKGROUND

In collaboration with members of the transgender and gender diverse (TGD) community, we created a didactic resource about the unique needs of TGD youth.

METHODS

We developed teaching materials enhanced by video clips of two TGD adolescents openly sharing aspects of their lived experience. We compared the video and no video conditions in a randomized controlled trial (RCT) in which participants were assigned to one of four parallel conditions: 1) a transgender [TgV] or 2) a cisgender [CgV] woman presenting with videos embedded into the presentation, 3) the same cisgender woman presenting without the videos [CgN], or 4) a no intervention control [NiC]. Our primary outcome was change in the total score of the Transgender Knowledge, Attitudes, and Beliefs Scale (T-KAB).

RESULTS

We recruited and proportionally randomized 467 individuals, 200 of whom completed ratings before and after the intervention: TgV (n = 46), CgV (N = 46), CgN (n = 44), and NiC (n = 64). Mean scores on all measures of TGD acceptance increased in the video group, compared to the no video group. Improvements persisted after 30 days (p < 0.01), except on perceptions about TGD family members. The three active intervention groups did not differ in efficacy.

CONCLUSIONS

These findings provide empirical evidence that a well-informed presenter, regardless of their gender, can achieve similar improvements in perceptions and knowledge about TGD youth when using a resource that can be disseminated free of cost.

Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda

There are growing concerns regarding the referral of children and youth with mental health conditions to emergency departments (EDs). These focus on upward trends in utilization, uncertainty about benefits and negative effects of ED visits, and inequities surrounding this form of care. A review was conducted to identify and describe available types of data on ED use. The authors' interpretation of the literature is that it offers compelling evidence that children and youth in the U.S. are being sent to EDs for mental health conditions at increasing rates for reasons frequently judged as clinically inappropriate. As a major health inequity, it is infrequent that such children and youth are seen in EDs by a behavioral health professional or receive evidence-based assessment or treatment, even though they are kept in EDs far longer than those seen for reasons unrelated to mental health. The rate of increase in these referrals to EDs appears much greater for African American and Latinx children and youth than White children and is increasing for the publicly insured and uninsured while decreasing for the privately insured. A comprehensive set of strategies are recommended for improving healthcare quality and health equity. A fact sheet is provided for use by advocates in pressing this agenda.