JustUs Health
Report date
June 2019
What has been most instrumental to your progress?
The transgender health advisory board participants (many of whom are transgender, or other members of LGBTQ community) have been instrumental to our progress over the past year. The providers and practitioners have been very willing to dig in and commit their valuable time to discussing and deliberating on the best way to develop connections between providers across the state. The group quickly grasped the community innovation model and have really taken ownership over the process, creating a decision-making process, developing a co-facilitation schedule, committing to monthly meetings rather than bimonthly or quarterly meetings. The board quite quickly realized we needed to reach out and include more folks in Greater MN from the beginning.Their willingness to discuss to their needs and experiences as providers working with transgender and gender non-conforming people in different areas of health care has resulted in vibrant discussions about how to build solutions that work across the state in different medical fields.
The structure and space to allow the identification and development of a better solution to the problem of transgender health disparities has been key to our progress this year. We started our first few meetings identifying what providers currently had and what the wished they had in the areas of networks/provider connections, resources/info/knowledge, and curriculum/education. By starting without any assumptions about what providers had access to or wanted to increase the knowledge and capacity to work with transgender people, we better identified problems and possible solutions. We've also been able to have more robust discussions and ideas by not having to immediately discuss the feasibility of different solutions right away. By taking the time to properly identify the barriers and problems providers are facing in working with transgender people, it often feels like we are moving faster than if we had assumed what ideas would work and had to go back when we realized our assumptions were wrong.
The 2019 Opportunity Conference JustUs Health hosted in April brought together providers, practitioners, policy makers, and advocates to advance LGBTQ health. Sharing the work of the transgender health advisory board at our annual Opportunity Conference gave us a quick way to get valuable feedback on our work from a wider range of providers across a variety of fields and geographic locations. The Opportunity Conference also gave us the chance to get more input and information from providers who aren't as familiar with working with transgender people, but want to expand their capacity. While we assembled an advisory board of people across a range of specialties (doctors, nurses, speech and language pathologists, surgeons, pharmacists, psychologists, and social workers), our members already have a strong track record of working with transgender people. Having structured conversations and feedback from people without as much knowledge and experience helped us more clearly refine what solutions we are going to try. The Opportunity Conference expanded our community engagement and required different strategies.
Key lessons learned
Working with an advisory board made up of providers from around the state and from different areas of practice affirmed that there is no one size fits all solution to increasing knowledge, expertise, and connection among providers working with transgender people. While we knew that different types of providers approach care from different perspectives frames and required different technical information and education regarding trans health, we thought that there would be more consensus on what sort of provider networking and connection would be useful and desired. Growing a network of providers to support transgender health care requires offering not only varying levels of knowledge, but also varying levels of engagement. Some providers will only want quick and immediately applicable information because they have one new transgender client and they've never worked with a trans person before. Other providers want sustained opportunities to discuss ongoing evolving practices, and to help shape the way health systems can interact with and support trans people along the continuum of care. Our work needs to address the knowledge gaps and networking needs of a wide array of providers.
Some of our advisory board members (both transgender and cisgender) have emphasized the need to center the experiences of trans people in work to advance trans health. Involving trans people in the work from the beginning is important in order to develop solutions that center the humanity and agency of trans people themselves. Doing work in the broad realm of health care, it is easy to sometimes slip into the paradigm of centering provider's knowledge and needs over the knowledge and needs of trans people. For example, the idea was floated for a while of having a 'provider only' section of the provider directory for providers to log into to discuss with each other and the trans people involved in the project highlighted how that model reinforced previous models of care where cisgender people dictated how and whether trans people accessed care. A different model that doesn't perpetuate a system where providers gatekeep transgender people from knowledge and access to care is necessary. I suppose you could characterize our assumption as a failure, but it doesn't feel like failure it feels like growth.
Reflections on inclusive, collaborative or resourceful problem-solving
Collaboration has been most important to making progress in our work. The transgender health advisory board we've assembled has relied heavily on the values of collaboration to overcome health care systems' tendency to isolate and silo providers by system and area of practice. By bringing together providers across health care systems and area of practice with collaboration as a key frame, we've been able to start addressing how to develop tools that aren't tied to any one health system. Collaboration has also helped shape our discussions so that the knowledge and expertise of providers in many areas, not just medical care, is utilized. Discussion and decision-making in a collaborative process means that while we move slower, we are all on the same page and feel confident in moving forward.
Collaboration has also meant that discussions of how any tools that emerge will from our project will be accountable and responsive to the needs of LGBTQ communities. The key inclusion of transgender people who do work in health care and health access is crucial to the project.
Collaboration has also meant that discussions of how any tools that emerge will from our project will be accountable and responsive to the needs of LGBTQ communities. The key inclusion of transgender people who do work in health care and health access is crucial to the project.
Other key elements of Community Innovation
No, collaboration and resourcefulness have been the two main elements that have contributed to our progress toward innovation.
Understanding the problem
The process itself of having the transgender healthcare advisory board lead themselves collaboratively through a process identifying needs and potential innovations with support from JustUs Health staff reiterates the importance of solutions that work for a variety of care providers and across the state. Having providers who will actually be utilizing any tools we develop involved in the process helps us devote time to solutions that get at the challenges providers have in finding information and networking.
We've also realized that there is just as much of a need for clear, easily accessible information on health care and health access for transgender people (and other LGBQ people), and that there's an overlap between what information providers want to refer their patients to and what information transgender and LGBQ people might need to find social and community support. Resources on how to find a provider, what to do if you experience discrimination, how to navigate insurance and where to turn if you need help are all crucial to improving the health access and experiences of transgender people.
We've also realized that there is just as much of a need for clear, easily accessible information on health care and health access for transgender people (and other LGBQ people), and that there's an overlap between what information providers want to refer their patients to and what information transgender and LGBQ people might need to find social and community support. Resources on how to find a provider, what to do if you experience discrimination, how to navigate insurance and where to turn if you need help are all crucial to improving the health access and experiences of transgender people.
If you could do it all over again...
I would go back and remind myself that change is part of the process. It's ok to not have all the answers or solutions, it's ok for our focus to shift, and it's ok for this to take time. Many ideas we had going into our project have changed as we have systematically discussed the needs and potential innovations to address the lack of knowledge and connection between providers working with trans people. For example, we thought a closed 'providers only' portal or section of the provider directory would be the best way to connect providers. We also thought that developing curriculum to implement in training programs for health care practitioners would be a part of our work. However, through discussion with advisory board members we realized that getting different schools to change their curriculum would be out of the scope of possibility for an external advisory board in two years. The community innovation process also developed ideas we never would've thought of, like an interactive chatbot for LGBTQ people and providers to interact with in order to find specific information or resources.
One last thought
We experienced a lot of organizational turnover at all staffing levels between September 2018 - April 2019. The initial lead staff member on this project left in September. However, the advisory board had been pulled together in August and has met every month, and we were ready to test some of their initial ideas at the Opportunity Conference in April. With stabilized leadership in JustUs Health, and consistent staffing in the grant for the second year, we look forward to continuing to advance this project.