(PS7-B34) Multidisciplinary Collaborations: Community and Provider Perspectives for Enhancing Communication-related Gender Affirmation Services

Background 

Behavioral health providers serving transgender and gender diverse (TGD) communities are typically part of a multidisciplinary team including medical providers, legal services, and, increasingly, speech-language pathologists (SLPs). SLPs are in a unique position to provide gender-affirming communication-related care for transgender and gender diverse (TGD) people. These services may focus on voice features, linguistic choices, and nonverbal cues to develop a communication style that is affirming and in line with a client’s gender identity. Referrals for such services may be a key element of a mental health treatment plan focused on reducing marginalization stress. However, limited evidence exists regarding the efficacy of communication-related gender affirmation services and, thus, standards for evidence-based, gender-affirming practices within speech-language pathology do not currently exist. Additionally, many TGD persons face barriers to care including past non-affirming interactions with medical providers, lack of insurance coverage, or difficulty identifying providers with relevant expertise. Perhaps most critically, there is a striking lack of input from TGD community members regarding SLP clinical service delivery, intervention goals, and development of research to build an evidence base. 

Methods 

To fill this gap in knowledge, the present study was designed in partnership with a community board of TGD persons. Together, researchers and board members developed two separate sets of questions for two focus groups. One group consisted of TGD community members and the other consisted of providers of gender-affirming care. Responses from six TGD community members and six providers of gender-affirming care were recorded, transcribed, coded, and analyzed using thematic content and narrative approaches to summarize data around each topic area. 

Results

Consistent themes emerged across each group that highlighted lack of awareness of available services, barriers to access, and limited connection among affirming providers of various disciplines as prevalent issues. TGD community members’ elaborations on these themes underscored that many were unaware that SLPs offer services to help align gender expression and identity, and those who did were not sure how to identify SLPs with this expertise. They wished that “safe” and trusted providers had a better system for referring clients across disciplines. Providers, in turn, expressed frustration with insurance denial of coverage for these services. Additionally, providers noted a struggle to balance the benefits of developing and widely publicizing TGD-friendly services versus the risks of providers of these services facing public backlash.  

Discussion

Many of the challenges identified in these findings are consistent with similar studies for mental health care. Awareness of communication-related gender affirmation care is important for behavioral health providers as their clients may not know of such services. Furthermore, providers may have to help their clients negotiate the barriers to care. Implications for practice and future research will be discussed.