Continuing to listen to trans voices

Nov 16, 2017


Happy Transgender Awareness Week 2017! According to GLAAD, this special week, Nov. 13 to Nov. 17, is set aside to “help raise the visibility of transgender and gender non-conforming people, and address the issues the community faces.”

In this space last year, we shared about the numerous steps Central City Concern was taking to ensure that our programs and services, as well as the staff members providing them, were as affirming and inclusive of our transgender patients and clients as possible. This year, we want to provide an update on our efforts to do so!

Trainings: CCC continues to offer trainings year-round to our staff members about working with trans and gender non-binary patients and clients. Several lead staff members have also made it a point to attend trainings hosted by community organizations so they can share what they learn with our program staff.

We continue to encourage our training attendees to approach the sessions from a place of humility. What Eowyn Rieke, CCC’s Associate Medical Director of Primary Care, said last year continues to apply to our approach: “We’re working toward a culture of humility as it relates to gender identity—recognizing that there are great differences at play here and that we need to be humble about our assumptions.”

"We’re working toward a culture of humility as it relates to gender identity—recognizing that there are great differences at play here and that we need to be humble about our assumptions.”
- Eowyn Rieke, Associate Medical Director of Primary Care

CCC Director of Equity and Inclusion Freda Ceaser says that this posture has provided the organization with a blueprint to fully operationalize trans affirming program services across the agency. She says that in the coming year, her goal is to work with every CCC program to begin an initial assessment of procedures and policies to become more trans affirming and inclusive.

“It’s so rewarding to see how the work of health services intentionally recognizes and affirms the identity of each of our patients. I want every person we serve, no matter their gender identity, to feel accepted, valued, and respected.” 

Trans Support Group: Chrysalis, the trans and gender non-binary support group that formed last year in response to what we heard from our patients, has been thriving. Open to patients of Old Town Clinic (OTC) and Old Town Recovery Center (OTRC), Chrysalis is a safe place where, according to facilitator Shanako Devoll, “people can talk about the difficulties of navigating everyday life and strategies used to address safety, mental health, and substance use.”

Group members say that Chrysalis helps them counteract the isolation they can feel by being part of a group that understands each other’s struggles and triumphs. At each session, attendees share their experiences, bring information about resources they’ve come across, and slowly build a community of shared experiences together.

The group meets bi-weekly. While the make-up of each meeting can differ, Chrysalis averages about five attendees each time the group comes together. Chrysalis is currently open to new members; in mid-December, the group will close for six weeks to allow the group members build trust and create the safe space they need.

"I want every person we serve, no matter their gender identity, to feel accepted, valued, and respected.”
- Freda Ceaser, Director of Equity and Inclusion

Electronic Health Records: Thanks to CCC’s amazing EHR implementation team, our health services can now make changes to patients’ gender identification information faster and easier than ever.  

Responding to the Needs of the Trans Community: As we continue to listen to our trans patients, we’re making changes that we believe are positive for them and the larger community.

All our multi-stall bathrooms inside OTC and OTRC now have signs that emphasize our support for individuals using the bathroom that best fits with their gender identity.

To better support trans patients and clients in substance use disorder treatment programs, our services are working toward making our urinalysis collection process more trans affirming.  

And finally, Margot Presley, an OHSU Doctorate of Nursing Practice candidate, used her doctorate project as a way to seek out and listen to trans voices at our Old Town Clinic. Margot’s project, “Patient Engagement in Quality Improvement: Raising the Voice of Transgender Patients Experiencing Homelessness” used patient engagement and qualitative inquiry techniques to interview people about their experiences as trans patients of OTC. Their feedback was used to recommend changes to our clinic operations with the goal of better meeting their needs.

Her manuscript is in process of being published in Transgender Health, “the first peer-reviewed, open access journal dedicated to addressing the healthcare needs of transgender individual;” Margot also presented a poster showing her work at several conferences. 

• • •

Each year, Trans Awareness Week leads up to the Trans Day of Remembrance on Nov. 20, an observance to honor and remember those whose lives were lost to acts of anti-trans violence. There are a number of events in the Portland metro area to participate in that day. All descriptions are from the event hosts: 

Thursday, Nov. 16
Keynote featuring Jennicet Gutiérrez: How to Get Involved, Hosted by Portland State Temprr Month and PSU Queer Resource Center
: Join us for our TEMPRR keynote panel event with activist Jennicet Gutiérrez! As a founding member of La Familia: Trans Queer Liberation Movement, Gutiérrez's activist experience with transgender rights and immigrant rights has given her great knowledge on how to get involved with various types of activism. This panel will also have local activists who will answer questions and share more about their activism. (Link) 

Friday, Nov. 17
5th Ave. Presents: ReAgitator, hosted at Fifth Avenue Cinema
: Join us in honoring Trans Day of Remembrance a few days early with an incredibly inventive film from independent trans-filmmaker Dylan Greenberg. Her film Re-Agitator: Revenge of The Parody, tells the bizarre story of a mad scientist using a cynical serum to revive a beautiful woman back from the dead leading to complete and total chaos. Using an arsenal of homages and spins off of classic and modern horror, Re-Agitator is bound to satisfy a weird and experimental itch. The film will feature an introduction from Dylan herself, including discussion of her experience with being an indie filmmaker and multi-media artist in NYC. This event will be donation-based instead of our regular ticketing prices, all proceeds will go to the artists. (Link) 

Sunday, Nov. 19
Trans Day of Remembrance March & Interfaith Vigil
: Please all Transgender folk and Cisgender allies join us in reverence and solidarity to honor the fallen and make a stand against Transphobia. We will gather at Terry Schrunk plaza for a staging and a brief program whereupon we will process to the First United Methodist Church for a candle lighting ceremony for the fallen and a message of hope and renewal from local area spiritual leaders followed by a reception where light refreshments will be served. (Link)

Monday, Nov. 20
Transgender Day of Remembrance 2017, hosted at Portland Community College
: This event is being planned by the Portland Transgender community, with the support of Portland Transgender organizations, Portland LGBTQIA2+ organizations, and allies, and is being led by Portland Transgender People of Color. (Link)

Transgender Day of Remembrance Memorial Meeting, hosted at Multnomah Friends Meeting House: We welcome you to join us on this day to mourn and honor the lives of those who have been murdered in the previous year because of anti-transgender hatred.

We gather to remember. We also gather to pray for, and to dedicate ourselves to work for, a world where transgender people are safe from hatred and violence. (Link)



Celebrating Transgender Awareness Week

Nov 18, 2016

Nov. 14 – Nov. 20 is Transgender Awareness Week! GLAAD describes this week as a time to “help raise the visibility of transgender and gender non-conforming people, and address the issues the community faces.”

The transgender patients and clients we serve at Central City Concern are a valued part of our vibrant community, but they also face a number of unique barriers. According to CCC Associate Medical Director of Primary Care, Dr. Eowyn Rieke, people who identify as transgender are more likely to have difficulty finding employment and accessing housing. This, of course, increases the chances they become homeless and live in poverty, which is often how they end up as CCC patients.

Roran Everheart, an urgent care medical assistant at our Old Town Clinic, adds, “There is an overriding fear of being outed and ending up on the street. There’s a fear of violence.”

Our mental health providers also see a relationship between people who struggle with questions about their gender identity in isolation, and mental illness and substance use disorders. “Oftentimes we see that someone’s gender identity struggles play such a role in their mental illness that we actually see a relief of symptoms when people can make steps toward living the life that they believe is rightfully theirs,” says Erika Armsbury, Director of Clinical Services at our Old Town Recovery Center. “And the same goes with substance use—we see people who use substances as a means to manage whatever it is they are struggling with around who they are with respect to gender.”

Roran, who identifies as trans, understands some of this firsthand. “I wasn’t able to transition until I got into recovery,” he shares. “Gender identity is so complex. When you’re trying to figure out what your gender identity is, it’s a strain on your mental state. From my own experience, it’s hard for me to imagine how hard it must be for someone who is also homeless, addicted, and also trying to transition.”

These are the very real issues that affect the transgender community we serve; they matter profoundly to us. We also know CCC must continue working to extend the values of equity and inclusion to more and more people. In fact, increasing equity is an explicit part of our organization’s strategic plan.

In that spirit, CCC—particularly our health services—has taken steps over the last year to make our agency is more trans affirming, trans inclusive, and responsive to the experiences of transgender individuals. Staff members formed working groups. They held meetings, brainstormed, and prioritized. They consulted with our own health care consumers and colleagues.

Since that call to action, CCC’s health services have made significant advances to address the unique issues our trans patients and clients experience.

Trainings
Within the past few months, every single CCC staff member across our primary care, mental health care, and substance use disorder programs has gone through a “Trans 101” training to provide an understanding of the basics. The information covered in these trainings was intended to demystify trans issues, as well as to learn how to be an ally and interact with transgender patients in appropriate, sensitive ways.

However, Eowyn emphasizes that this is not about cultural competence; instead, it’s about humility. “Competence implies that we who don’t identify as trans ‘get it.’ Instead, we’re working toward a culture of humility as it relates to gender identity—recognizing that there are great differences at play here and that we need to be humble about our assumptions.”

Old Town Clinic primary care providers received additional training on the basic medical care of transgender patients. In a separate two-session training, mental health providers at Old Town Recovery Center learned about working with transgender patients during the transition process, as well as their responsibilities related to writing assessment and approval letters for patients hoping to transition.

“We want to be sure out providers are on the same page,” Erika says. “[Providing letters] is something we want to offer our patients consistently, but it’s important for us to improve our larger understanding of trans issues because, for us and our patients, the letter isn’t the ultimate goal, nor is it the end of their journey.”

Providing CCC health staff with information doesn’t just benefit them. It’s also a way to take a common burden off our trans patients. As Roran says, “Having to train your doctor to be trans aware can be so exhausting.” Staff members who are aware of trans patients’ experiences drastically reduces the chances of retraumatizing patients with insensitivity and judgment. Instead, calling back to CCC’s goal of cultural humility, Erika says, “Even if we aren’t experts, we know enough to be open and accepting. We honor their experiences and all the things they come to us with. We can show that we want to work with them to tease out the severe mental health hardships while also supporting them around their gender identity.”

Transgender Support Group
Patients of Old Town Clinic and the Old Town Recovery Center can now find a community of support, thanks to a new group co-facilitated by Roran and Shanako DeVoll. Though in its early stages, Roran sees great potential for the group, named “Chrysalis.”

“A lot of our clients are pretty isolated in their lives,” Roran says. “When you start to navigate your gender identity without supportive family or friends, it can be lonely to not have that sounding board. This group gives them a chance to meet other people who identify as trans.”

The hour-long support groups make room for organic conversation to talk about struggles and victories, resources, and relevant topics. Roran and Shanako co-facilitate, but the group itself is largely client-led. It begins open for anyone for two meetings, then closed for the following three months to give the group time to develop a sense of community and trust. After, the group open up again. That sense of trust, Roran says, is imperative to our clients.

“Many of our clients face mental health and addiction challenges. There are already lots of groups out there for trans people, the feeling is that many of them feel cliquish. Clients with mental health challenges may not be able to navigate the social cues at larger, more established groups, so having someone like Shanako, a mental health professional, on board is great.”

Roran hopes to see the support group thrive. Early signs show interest is high, and people appreciate this opportunity to find an accepting community. “I hope that people want to come back all the time and that this first group will invite their friends to this awesome group they’ve discovered.”

Adapting Electronic Health Records
In a health care setting, it’s easy to forget infrastructure and technology can carry the same biases and blind spots that we seek to mitigate. Thankfully, CCC health services didn’t forget, and instead spearheaded substantive changes to our Electronic Health Records (EHR) system to, as Eowyn says, “reflect this culture change of becoming more trans affirming and inclusive that we’re working to embed within the organization.”

The most immediate and noticeable change is the banner when one pulls up a patient’s record. There, at the very top, is now an area that shows the patient’s pronoun and preferred name. Though small, this change will help staff interact much more appropriately in the way that the patient identifies.

The EHR system will also help health care staff ask appropriate questions related to gender identity and sexual orientation, in both content and word choice. Staff members performed hours of research to learn about best practices for asking these questions, then adapted it to CCC’s culture to be even more inclusive than what the current body of research suggests. The goal, according to Eowyn, is to structure these questions in a way so “as many people as possible have a place to feel like they belong.”

Better, more inclusive questions means gathering better, more inclusive responses. This, ultimately, will help CCC health services track how we are serving our transgender patients as a whole. In that vein, an OHSU Doctorate of Nursing student is planning a period of focus groups and one-on-one interviews during which trans patients and clients can provide direct feedback about how CCC is doing and how we can continue to improve.

Keeping the Trans Community Visible
Finally, CCC will continue to be intentional about talking about trans issues, whether internally within the CCC community, or externally with partners and constituents. (Even this blog post is part of that effort!)

According to Erika, “The more we talk about [trans issues], the more we see it, and the more we work with people who identify as trans in a safe, open, and aware way, it will have a ripple effect in the public.”

Knowing that, CCC will continue to bring stories of our trans patients, as well as the work we do to, as Erika says, “give people an opportunity for people to live as they see themselves.”