People who are transgender and people experiencing homelessness are two of society’s most vulnerable and marginalized populations. There is ample evidence that many in the transgender community are stigmatized and victims of prejudice and violence in many aspects of their lives, affecting their ability to access health care, housing, education, and employment. Similarly, people experiencing homelessness face heightened threats of violence, trauma, and discrimination compared to those who are housed. For people who are both transgender and experiencing the hardships of homelessness, the risk and impact of victimization and stigmatization is magnified even further. Too often, transgender people are alienated from the health care system due to previous episodes of ridicule and discrimination. This has led many transgender people to delay seeking medical care and presenting late in the course of chronic disease with evidence of long neglect of chronic problems. People experiencing poverty and homelessness are similarly exposed to stigma and barriers to mainstream medicine, leading to delayed diagnoses and preventable health crises.
Central to BHCHP’s mission is a fierce commitment to health equity and assuring access to the highest quality health care for the most vulnerable and marginalized members of our community. Understanding the barriers that people who are both homeless and transgender face in accessing high quality, culturally competent health care, in 2008, BHCHP endeavored to create a safe, supportive place dedicated to providing accessible health care services to people experiencing homelessness and identifying as transgender. Since the inception of this program, BHCHP has grown its expertise in transgender care, informed by the firsthand perspectives of our consumers; we currently care for nearly 90 transgender primary care patients.
In 2018 BHCHP set about applying for the Human Rights Campaign’s Health Equality Index (HEI) designation as an “LGBTQ Health Care Leader.” As described above, BHCHP has had a vibrant Transgender Program in place since 2008 and throughout the years we have had many openly gay and lesbian staff members who felt accepted and supported at work. It felt like getting this designation would be a slam dunk, especially because we had the T part of LGBT covered. We had already overcome what is often the biggest challenge for many health care institutions- creating and operating a thriving transgender program which provides excellent health care in a context of cultural humility and sensitivity.
Upon reviewing the HEI scoring criteria it became clear that even as a program that strives to be intentional about equity, we had a lot of work to do! The scoring criteria included things like:
“Does your organization have written gender transition guidelines documenting supportive policies and practices on issues pertinent to a workplace gender transition?”
“Are your organization’s hiring/recruitment efforts explicitly LGBTQ-inclusive?”
“Does you organization have a public way to make LGBTQ-knowledgeable and friendly providers known as such to interested patients or provide a confidential referral mechanism to make LGBTQ-specific referrals?”
We had none of that!
I reached out to our Chief Equity and Inclusion Officer, Sonja Spears, who was newly hired. It was a perfect collaboration as we put our heads together and strategized on how to move BHCHP forward. It was time to initiate a Taskforce! We gave ourselves a year to get up to speed.
We used the HEI scoring criteria to guide the structure of our Taskforce and soon we had a dedicated group of people signed up to work on the various areas of focus:
Non-Discrimination and Staff training
Patient Services and Support
Employee Benefits and Policies
Patient and Community Engagement
Employee representatives from almost every type of work at BHCHP got involved. Our CEO Barry Bock and four senior managers completed two hours of “Executive Briefing Training” which was required of first-time HEI participants. Some examples of what our HEI Taskforce facilitated:
- Assured that our patient satisfaction survey includes options for patients to identify their sexual orientation and gender identity
- Assured that our online career page includes the information that BHCHP employs people without regard to, among other things, sexual orientation and gender identity or expression
- Created a link via our electronic health record to easily refer patients to Boston Medical Center for gender transition services outside the scope of BHCHP, such as surgery and voice therapy
The process was very rewarding because it generated important discussions and highlighted ways in which we could improve on our mission to provide excellent care and equitable practices. In August 2019 We received word that we did indeed qualify for 2019 LGBTQ Health Care Leader status. We are quite proud! Our HEI Taskforce has now become a standing committee and we will continue our efforts to make BHCHP as accessible and friendly as possible to LGBTQ patients and staff. We can always do more!
Pam Klein, RN, MSN
BHCHP Transgender Program Nurse Manager