Gender and Sexuality Commons^™

The Often‑Circuitous Path To Affirming Mental Health Care For Transgender And Gender‑Diverse Adults, Natalie Holt, Debra Hope, Richard Mocarski, Nathan Woodruff

Trans Collaborations Academic Papers

Purpose of Review We describe recent research regarding access to affirming mental health services for transgender and gender-diverse (TGD) adults and explore new resources available for therapists to inform evidence-based practice with TGD clients.

Recent Findings Barriers and facilitators at all socioecological levels impact TGD adults’ mental health help-seeking. TGD adults often interface with mental health providers while accessing gender-affirming medical care, though new standards of care are likely to alter this typically common path to mental health services. Efforts to improve therapist education, such as therapy manuals, are increasingly available and a necessary step to increase the number of …

Mitigating The Mental Health Impact Of Marginalization And Discrimination, Debra A. Hope

Trans Collaborations Academic Papers

In honor of the life and work of Aaron T. Beck, this paper describes the application of cognitive therapy to management of marginalization stress among minoritized communities. Collaborative empiricism, cognitive restructuring, and behavioral interventions are highlighted as being particularly useful in a contemporary multicultural approach for the anxiety, depression, stress, and other sequelae of marginalization due to a stigmatized identity. Although primarily illustrated through recent work with transgender and gender diverse adults, the discussion extends to other groups including racial, ethnic, and sexual minorities and immigrants. This work illustrates the power of Dr. Beck’s approach to address the presenting concerns …

Test–Retest Reliability And Sensitivity Of A Brief Clinical Monitoring Measure For Transgender And Gender Diverse Adults: The Trans Collaborations Clinical Check-In (Tc3), T. Zachary Huit, Natalie R. Holt, Alexander Farquhar-Leicester, Rebecca L. Brock, Richard Mocarski, Nathan Woodruff, Debra Hope

Trans Collaborations Academic Papers

The current study aimed to examine the test–retest reliability and sensitivity of the Trans Collaborations Clinical Check-In (TC³) in a 3-month period with four assessment points at baseline, 1, 2, and 3 months to examine its utility as a clinical progress monitoring measure. This study builds on the initial validation study conducted by Holt et al. (2019). The sample of 32 transgender and gender diverse (TGD) participants were chosen who met screening for at least modest depression and anxiety, and did not have other significant risk factors (e.g., mania, self-harm). Participants completed a battery of measures that assessed …

Bridging The Gap Between Practice Guidelines And The Therapy Room: Community-Derived Practice Adaptations For Psychological Services With Transgender And Gender Diverse Adults In The Central United States, Debra A. Hope, Natalie Holt, Nathan Woodruff, Richard Mocarski, Heather M. Meyer, Jae A. Puckett, Joshua Eyer, Shelley Craig, Jamie Feldman, Jay A. Irwin, John Pachankis, K. J. Rawson, Jae Sevelius, Sim Butler

Trans Collaborations Academic Papers

Individuals who identify as transgender and gender diverse (TGD) are presenting at mental health clinicians’ offices with increasing frequency. Many TGD clients are seeking care related to affirming their gender identity but also may present with anxiety, depression, trauma, substance abuse, or other problems forwhich a clinician may commonly provide services. Some clinicians may hesitate to accept TGD clients into their practice if they have little specialized training to work with this population in an affirming manner, especially in more underserved areas where a generalist practice is the norm. Numerous professional associations and experts have developed guidelines for affirmative behavioral …

Educational Preparedness To Care For Transgender And Gender Diverse Adults: Perspectives Of Mental Health Professionals, Sharon N. Obasi, Robyn E. King, Natalie R. Holt, Richard Mocarski, Debra A. Hope, Nathan Woodruff

Trans Collaborations Academic Papers

Ensuring that mental health professionals are appropriately trained to provide affirming and sensitive care to transgender and gender diverse (TGD) adults is one mechanism that may reduce the marginalization sometimes experienced by TGD adults in mental health contexts. In this study, mental health professionals (n = 142) completed an online survey documenting the sources and types of training received to provide TGD-sensitive care; and, shared a self-assessment of their comfort, competence, and ability to provide TGD-sensitive care. Findings revealed that the majority of the mental health professionals in the study (approximately 81%) received specific training to work with TGD …

Advocacy Opportunities From Academic- Community Partnerships: Three Examples From Trans Collaborations, Debra A. Hope, Nathan Woodruff, Richard Mocarski

Trans Collaborations Academic Papers

For a number of years, much of what we know about marginalized communities from psychological research, even most social science work, came from the perspective of “research on” a particular marginalized group, with the majority group as the “healthy” reference sample (Awad et al., 2016). In part, this occurred because very few researchers are themselves members of these communities. In addition, researchers would come into a community, collect their data, and leave, with little ongoing benefit to the community itself. Over time, this exploitation led to communities becoming more suspicious of researchers (e.g., Christopher et al., 2008). Recognizing the problem, …

A Systematic Review Of Recommendations For Behavioral Health Services For Transgender And Gender Diverse Adults: The Three-Legged Stool Of Evidence-Based Practice Is Unbalanced, Natalie Holt, Allura L. Ralston, Debra A. Hope, Richard Mocarski, Nathan Woodruff

Trans Collaborations Academic Papers

There is a growing literature of clinical recommendations for transgender and gender diverse (TGD) affirming behavioral health care, yet it is unknown to what extent these recommendations are rooted in evidence-based practice (EBP). This systematic review included 65 articles published between 2009 and 2018 with recommendations for behavioral health services with TGD adults, emphasizing general clinical care. Coded variables included type of article, participant demographics, aspects of EBP, and whether care was informed by objective assessment. Most articles did not equally draw from all components of EBP. Recommendations for specific clinical problems are increasingly available and address diversity within TGD …

Specialists In Name Or Practice? The Inclusion Of Transgender And Gender Diverse Identities In Online Materials Of Gender Specialists, Natalie Holt, Robyn E. King, Richard Mocarski, Nathan Woodruff, Debra A. Hope

Trans Collaborations Academic Papers

Recommendations for health care providers working with transgender and gender diverse (TGD) individuals emphasize affirming clients’ identities, such as using correct pronouns and name, however it is unknown how often gender specialists adhere to such recommendations. Websites and intake forms of gender specialists were coded for use of affirming language, asking for pronouns and chosen name, and mention of TGD specialties and resources. Most websites identified the provider’s specialty to work with TGD individuals, though much fewer provided additional resources concerning TGD issues and only half of intake forms included affirming language. Given previous research that has demonstrated providers working …

Psychometric Evaluation Of The Transgender Congruence Scale, T. Zachary Huit, Allura L. Ralston, J, Kyle Haws, Natalie Holt, Debra A. Hope, Jae Puckett, Richard Mocarski, Nathan Woodruff

Trans Collaborations Academic Papers

Introduction Despite increased attention to transgender and gender diverse (TGD) issues in psychological literature during the past decade, gaps remain for psychometric validation of TGD-specific measures. Kozee et al. (Psychology of Women Quarterly 36(2):179–196, 2012) addressed such gaps by creating the Transgender Congruence Scale (TCS), measuring gender acceptance and feelings of gender congruence between internal and external attributes across a broad range of gender identities. The current study extended Kozee and colleagues’ work by further examining the psychometric properties of the TCS.

Methods Between October and November of 2017, 210 transmasculine, transfeminine, and gender diverse adults between ages 19 …

The Provider Perspective On Behavioral Health Care For Transgender And Gender Nonconforming Individuals In The Central Great Plains: A Qualitative Study Of Approaches And Needs, Natalie Holt, Debra A. Hope, Richard Mocarski, Heather Meyer, Robyn King, Nathan Woodruff

Trans Collaborations Academic Papers

Purpose—Transgender and gender nonconforming (TGNC) individuals interact with mental health care systems at high rates and experience substantial barriers to care. Rural TGNC individuals face additional disparities in accessing appropriate mental health services. Little research has focused on the mental healthcare providers who work with TGNC individuals in underserved areas. The current study sought to describe the mental health care services delivered by providers perceived as affirming by TGNC community members in the Central Great Plains.

Methods—We conducted qualitative interviews with 10 providers to understand how providers seek cultural competency and conceptualize and work with their TGNC clients given the …

Trans Collaborations Clinical Check-In (Tc3): Initial Validation Of A Clinical Measure For Transgender And Gender Diverse Adults Receiving Psychological Services, Natalie R. Holt, Terrence Z. Huit, Grant Shulman, Jane L. Meza, Jolene Smyth, Nathan Woodruff, Richard Mocarski, Jae Puckett, Debra A. Hope

Trans Collaborations Academic Papers

One key aspect of evidence-based psychological services is monitoring progress to inform treatment decision making, often using a brief self-report measure. However, no such measure exists to support measurement based care given the distinct needs of transgender and gender diverse people (TGD), a group facing large documented health disparities and marginalization in healthcare. The purpose of the present study was to develop and provide initial psychometric validation of a short, behavioral health progress monitoring self-report measure, the Trans Collaborations Clinical Check-in (TC3). TGD communities, providers identified as TGD-affirmative, and relevant academic experts contributed to item and scale development. The final …

First Impressions Online: The Inclusion Of Transgender And Gender Nonconforming Identities And Services In Mental Healthcare Providers’ Online Materials In The Usa, Natalie Holt, Debra A. Hope, Richard Mocarski, Nathan Woodruff

Trans Collaborations Academic Papers

Background: When accessing mental healthcare services, transgender and gender nonconforming (TGNC) individuals face systemic barriers to gender-affirmative care. Initial points of contact, like intake forms, may show limited consideration for the heterogeneity of TGNC identities and can lead to negative consequences prior to face-to-face interaction with providers.

Aims: The first aim was to mimic a likely pathway a TGNC individual may follow to seek mental healthcare services in the USA and to describe the extent to which they may encounter enacted stigma or affirmative messages that may impede or facilitate access to care. The second aim was to determine if …

Unmet Expectations In Healthcare Settings: Experiences Of Transgender And Gender Diverse Adults In The Central Great Plains, Heather Meyer

Trans Collaborations Academic Papers

Transgender and gender diverse (TGD) individuals face a long-term, multi-faceted process if they choose to begin a gender affirmation journey. Decisions to go on hormone therapy and/or have a surgical procedure necessitate the TGD individual to set up an appointment with a healthcare provider. However, when TGD patients interact with healthcare practitioners, problems can arise. This article documents and categorizes the types of unmet expectations that are common in the TGD patient-healthcare provider social dynamic in the Central Great Plains of the United States. Utilizing a community-based participatory research model, qualitative in-depth interviews were conducted with 27 TGD individuals about …

Examining The Effects Of A Service-Trained Facility Dog On Stress In Children Undergoing Forensic Interview For Allegations Of Child Sexual Abuse, Cheryl A. Krause-Parello, Michele Thames, Colleen M. Ray, John Kolassa

Department of Sociology: Faculty Publications

Disclosure of child sexual abuse can be a stressful experience for the child. Gaining a better understanding of how best to serve the child, while preserving the quality of their disclosure, is an ever-evolving process. The data to answer this question come from 51 children aged 4–16 (M = 9.1, SD = 3.5), who were referred to a child advocacy center in Virginia for a forensic interview (FI) following allegations of sexual abuse. A repeated measures design was conducted to examine how the presence of a service-trained facility dog (e.g. animal-assisted intervention (AAI) may serve as a mode of lowering …

Tailoring General Population Surveys To Address Participation And Measurement Challenges Of Surveying Lesbian, Gay, And Bisexual People, Mathew Stange

Survey Research and Methodology (SRAM) Program: Dissertations and Theses

Being rare and stigmatized, lesbian, gay, and bisexual (LGB) people are hard-to-survey. Gaining their participation, reducing concealment of LGB identity, and accurately measuring their marital status are challenging. In this dissertation, I examine the effects that LGB-inclusive tailoring—inclusive cover image design and “same-sex” and “opposite-sex” marital status categories—has on addressing these challenges; particularly, the effect on who responds to a survey and the answers that they provide, among LGB and non-LGB people. The experiments were embedded in the 2013 Nebraska Annual Social Indicators Survey (NASIS), a general population mail survey of Nebraskans (n=1,608). I test how the LGB-inclusive cover design …

Examining Identity Consolidation Processes Among Ethnic Minority Gay Men And Lesbians, Heather R. Kennedy, Rochelle L. Dalla

Department of Child, Youth, and Family Studies: Faculty Publications

Past scholarship has demonstrated shortcomings in developmental theories for both sexual and ethnic identity. Furthermore, identity development may be especially challenging for members of multiple minority groups facing significant social stressors. The primary goal of this study was to explore identity consolidation processes among individuals with intersecting minority identities. Using in-depth, personal interviews and self-report measures, data were collected from 16 ethnic minority gay men and lesbians. Themes such as acceptance, invisibility, and fear confirm the influence of social context on identity integration. Findings revealed differing magnitudes of consolidation. Greater social support and educational endeavors were critical factors in distinguishing …

An Entrepreneurial Approach To Career Development, Connie I. Reimers-Hild

Kimmel Education and Research Center: Presentations and White Papers

This article explains how people can use an entrepreneurial approach to career development in and effort to advance their careers and employment opportunities.

Exiting Prostitution: An Integrated Model, Lynda M. Baker, Rochelle L. Dalla, Celia Williamson

Department of Child, Youth, and Family Studies: Faculty Publications

Exiting street-level prostitution is a complex, convoluted process. Few studies have described this process within any formal conceptual framework. This article reviews two general models and two prostitution-specific models and their applicability to the exiting process. Barriers encountered as women attempt to leave the streets are identified. Based on the four models, the barriers, the prostitution literature, and the authors’ experience with prostituted women, a new integrated six-stage model that is comprehensive in scope and sensitive to women’s attempts to exit prostitution is offered as a foundation for continued research on the process of women leaving the streets.

“All The Men Here Have The Peter Pan Syndrome— They Don’T Want To Grow Up”: Navajo Adolescent Mothers’ Intimate Partner Relationships—A 15-Year Perspective, Rochelle L. Dalla, Alexandria M. Marchetti, Elizabeth (Beth) A. Sechrest, Jennifer L. White

Department of Child, Youth, and Family Studies: Faculty Publications

In 1992 and 1995, data were collected from 29 Navajo Native American adolescent mothers. In 2007 and 2008, data were collected from 21 of the original 29 (72%). Guided by feminist family theory, this investigation sought to (a) examine Navajo adolescent mothers’ intimate partner relationships during the transition to parenthood, (b) identify themes in the young mothers’ intimate partnerships across time, and (c) assess participants’ psychosocial well-being in adulthood. Four themes emerged in the women’s long-term intimate relationships: limited support, substance abuse, infidelity, and intimate partner violence. Implications of the findings and suggestions for future research are discussed.